DET PSYKOLOGISKE FAKULTET

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Dance as therapy:

An investigation of available evidence in the field of Dance/Movement Therapy, and plausible mechanisms behind potential effects

HOVEDOPPGAVE

profesjonsstudiet i psykologi

Birgit Kweh

Vår 2011

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Veileder: Torill Christine Lindstrøm

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Acknowledgements

Dance has always been a part of me. The idea behind this paper was a curiosity of weather

something as abstract as dance could be united with the scientific field of psychology, as well

as an interest in alternative treatment methods for those who are not able to engage in, or for

some reason do not benefit from, verbal psychotherapy.

I want to thank my supervisor, Torill Christine Lindstrøm, who through her critical questions

and highly constructive feedback, made me perform my best, even when I was heavily

pregnant.

Thanks to Tine who held an inspiring workshop in creative dance, and to Steg Dans &

Trening, where I got to develop ideas and reflections upon dance as therapy. Thanks to

friends and family for discussions and encouragement.

I also want to thank my husband, Michael Kweh, who always motivates me and gives me the

push I need to get where I want. Thanks to my lovely son, Daniel, who was inside my

stomach during most of the writing process. He made me feel sick, and he made my back

hurt, but he also gave me an amazing body awareness that inspired me.

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Abstract

Several different treatment interventions use physical movement in order to enhance

mental health. Among these is Dance/Movement Therapy. In this form of treatment, dance is

used as a tool to integrate physical, cognitive, and emotional experiences. In this paper,

questions are raised about whether Dance/Movement Therapy has any effect, and if so, for

whom it has what effect, and what the underlying mechanisms may be. Loosely defined

concepts and associations to non-scientific methods make the field rather bewildering.

Nevertheless, this paper attempts to evaluate research in order to answer the questions

mentioned above. Due to methodological flaws in many of the studies, no absolute

conclusions can be drawn. Still, results from the reviewed research suggest that

Dance/Movement Therapy might contribute to reduce anxiety and depression, enhance some

aspects of physical function in certain patient groups, and possibly increase cognitive

functioning among the elderly. Evidence of other effects, for instance on psychotic disorders

and mental disorders among children, is not found. Various theoretical assumptions regarding

underlying mechanisms are claimed among the practitioners of Dance/Movement Therapy,

but minimal research is done to test these out. Despite this, possible underlying mechanisms

are presented in the discussion, where the importance of more knowledge in this area is

emphasized. In particular, more adaptive affect regulation is discussed as a possible

mechanism through which dance therapy may enhance health.

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Sammendrag

Mange ulike behandlingsmetoder benytter seg av fysisk bevegelse for å bedre mental

helse. Blant disse er danseterapi. I denne behandlingsformen brukes dans som et verktøy til å

integrere fysisk, psykisk, kognitiv, og emosjonell erfaring. Denne oppgaven tar for seg

spørsmål om hvorvidt danseterapi har effekt, og i tilfelle for hvem det har hvilke effekter, og

hvilke mekanismer som står bak. Løselig definerte begreper og assosiasjoner til

uvitenskapelige metoder gjør feltet noe forvirrende. Denne oppgaven vil likevel evaluere

tilgjengelig forskning for å forsøke å besvare de overfornevnte spørsmålene. På grunn av

metodologiske problemer i mange av studiene kan ingen absolutte konklusjoner trekkes.

Resultatene fra de gjennomgåtte studier kan likevel sies å gi en viss evidens for at danseterapi

kan bidra til å redusere angst, minske depresjonssymptomer, bedre enkelte aspekter av den

fysiske funksjonen hos noen pasientgrupper, og muligens øke kognitiv fungering blant eldre.

Evidens for ytterligere effekter, på blant annet psykotiske lidelser og psykiske lidelser hos

barn, er ikke funnet. Mange ulike teoretiske antakelser om bakenforliggende mekanismer er

hevdet blant utøvere av danseterapi, men det er gjort lite forskning for å teste ut disse. Til

tross for dette presenteres mulige bakenforliggende mekanismer i diskusjonen, hvor

viktigheten av mer kunnskap på dette området vektlegges. Mer effektiv affektregulering

drøftes videre som en mulig mekanisme som danseterapi kan virke gjennom for å ha en

helsefremmende effekt.

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Table Of Contents

1.0 Introduction …........................................................................................................... p. 8

1.2 The characteristics of dance …........................................................................ p. 8

1.3 Dance as therapy …......................................................................................... p. 10

1.4 Aim of the paper ….......................................................................................... p. 11

2.0 Clarification of concepts …....................................................................................... p. 13

2.1 Dance Movement Therapy (DMT) ….............................................................. p. 13

2.2 Regulation of affect …..................................................................................... p. 14

3.0 Psychological theories on movement and affect …................................................. p. 16

3.1 Wilhelm Reich and body-focused therapy ..................................................... p. 17

3.2 Developmental psychology …......................................................................... p. 18

4.0 DMT: CONTEXT AND APPLICATIONS .............................................................. p. 19

4.1 Art therapies …............................................................................................... p. 19

4.2 The history of DMT …................................................................................... p. 20

4.3 Areas of application ….................................................................................... p. 21

4.4 What are the factors in DMT treatment that are assumed to promote change? p. 23

5.0 Research on DMT ….................................................................................................. p. 25

5.1Anxiety …......................................................................................................... p. 26

5.2 Biological markers and depression .................................................................. p. 28

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5.3 Psychosis …..................................................................................................... p. 31

5.4 Physical measures ............................................................................................ p. 32

5.5 DMT with children …...................................................................................... p. 33

5.6 DMT in geriatric care ….................................................................................. p. 36

5.7 Body awareness, body image and self-esteem …........................................... p. 37

6.0 Discussion …................................................................................................................ p. 39

6.1 What does available evidence suggest about effects of DMT? …................... p. 39

6.1.1 Evaluation …................................................................................... p. 41

6.2 What factors in DMT can be assumed to cause the effect? …........................ p. 42

6.2.1 Exercise …........................................................................................ p. 43

6.2.2 Music …............................................................................................ p. 44

6.2.3 Creativity …...................................................................................... p. 45

6.2.4 Group cohesion or relationship to the therapist ............................... p. 45

6.2.5 Other factors suggested …................................................................ p. 46

6.3 Is there any evidence to support the notion of DMT affecting

affect regulation? …........................................................................................ p. 47

7.0 Conclusion …............................................................................................................. p. 49

8.0 References ….......................................................................................................... p. 51

9.0 Appendix: Table of quantitative studies on DMT …................................................. p. 68

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1.0 Introduction

It has long existed a belief that body and mind is connected, which is evident in the

language. The Latin root of the word “emotion”, has a clear connection to movement. It stems

from the word “movere”, to move, with the suffix “e”, meaning out (Callahan & McCollum,

2002). In spite of the deep roots that modern science has in Descartes' dualism (Devlin, 1996),

there is now generally little doubt that bodily and mental processes are intricately intertwined

(Damasio, 1998). Research has demonstrated a reciprocal relationship between motion and

emotion as neurophysiologic correlates, whether it comes to muscular, attitudinal or

psychological states (Berrol, 1992). There exist a wide array of psychotherapeutic treatments

that in different ways draws on the assumption that mental states can be revealed and

influenced through bodily movement. Some of these are 'character analysis' (Reich, 1972) and

the closely related but wider field of 'body psychotherapy' (Stounton, 2002), 'psychodrama'

(Moreno, 1946), and 'dance/movement therapy' (Ritter & Low, 1996; Stanton-Jones, 1992).

This thesis will explore whether there is reason to assume that movement and dance as

therapy has a positive effect on mental health. One mechanism through which these

interventions might possibly work will be elaborated, this is through enhancing the ability to

regulate affect. As efficient ability to regulate affect is seen as central to maintaining or

achieving a good mental health (Bradley, 2003), it is reasonable to believe that any therapy

that is efficient in terms of enhancing abilities to recognize and express affect, is an efficient

treatment.

1.1 Characteristics of Dance

Dance is movement in a rhythmic fashion, but there are rhythmic movements that

cannot be characterized as dance. For the movement to be called dance, it must be performed

to express something, or convey an impression (Grönlund, 1991). In modern, western

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cultures, dance is known as a performance art. However, dance is also used in all cultures,

formally or informally, as a social activity. It can also have a ritual character, and has been

used to celebrate for instance births, marriages, harvests, and wars (Sachs, 1937).

Literature suggests that dance can increase positive affect and decrease negative affect

(Bartholomew, 2002), reduce anxiety (Leste & Rust, 1990), improve coping in cancer patients

(Cohen, 1999) and relieve arthritis (Noreau, Moffet, Drolet & Parent, 1997). But little is

known about which mechanisms are causing these effects. There are several important aspects

in dance that separately may influence the dancer in different ways.

First of all, dance is a form of physical activity. There is evidence that physical

activity not only enhances physical health and increase life expectancy, but also enhance life

quality and reduce symptoms of depression and anxiety (Byrne & Byrne, 1993; Lane, 2001;

Ommundsen, 2000; Stathopoulou, Powers, Berry, Smits & Otto, 2006; Taylor, 2006). Thus,

research on the effects of dance will have to control for the general effect of physical activity

in order to discover any additional effects.

Exercise intensity was not found to correlate with changes in affect in one study

(Barthelomew, 2002). The author therefore attributes the affect to feelings of accomplishment

or mastery, and claim that to master something new can enhance the sense of self, leading to a

better self image, and possibly decrease negative emotions.

A central element of dance is rhythm. Rhythm is a common factor for several kinds of

art therapies; music therapy, dance therapy and poetry. Research suggests that “the infant's

sympathy arises from an inborn rhythmic coherence of body movement and modulation of

affective expressions” (Trevarthen & Mallock, 2000). Rhythm has been believed to contribute

to healing in many non-western cultures (Berrol, 1992), for instance African tribal dances

(Hanna, 1978), as well as shamanic traditions among Indonesians, Australian Aboriginals,

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North-American Indian, Alaskan Eskimos and South-American Indians (Moreno, 1988).

Autonomic responses appear to adjust to external perception of rhythm (Snyder, 1972), and

music may have a calming effect on the body (Berrol, 1992). In a study on rhythmic auditory

stimulation and experience of “trance” the subjects was found to have increased levels of

adrenaline, noradrenaline, and cortisol initially, only to quickly decrease below normal level.

Levels of beta-endorphins were found to increase both during and after the trance experience,

which might explain the reported feelings of euphoria (Goodman, 1986). Release of

endorphins can help avoid pain sensation, and may also improve the immune function

(Achterberg, 1985). It has further been suggested that rhythm can have a positive effect on

health, being a necessary component in inducing “altered states of consciousness” (Woods,

2009), or help a person being conscious of the moment and experience “flow”

(Csikszentmihalyi, 1990).

Another element common for art therapies is creativity. Creativity is associated with

psychological traits such as openness, flexibility, and autonomy – traits that are seen as

beneficial to one’s mental health. It is suggested that increasing a person’s creativity can

possibly enhance mental health (Cropley, 1990). The author refers to a study by Krystal

(1988) were it was found that extremely uncreative people had difficulties with self-care, and

were lacking a sense of self-coherence. Some studies have tried to see whether practical

creativity training in different ways can increase mental health (Schwarzkopf, 1981;

Herrmann, 1987), and the results offer some support to this notion.

Last but not least, dance is often performed in groups, and can therefore include a

social component as well. Synchronicity in movements may cause the dancers to experience

some kind of connection, or belonging (Levy, 1988).

1.2 Dance As Therapy

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Dance as therapy has its roots in dance as art, but has developed as an independent

discipline (Berrol, 1992). In dance as an art form, aspects such as technique, choreography

and aesthetics are important. Dancers work towards perfection in performance. In dance

therapy the goal is rather to explore new ways of being and feeling, and so the focus is turned

inward (Stanton-Jones, 1992). Aesthetic concerns are ignored, and the “nature [of dance] is

explained in psychological, sociological and historical terms” (Payne, 1990). It is possible

that dance in itself can be therapeutic, and several authors have attempted to distinguish

“therapeutic dance” from “dance therapy”, or “dance movement therapy” (Karkou &

Sanderson, 2000; Meekums, 2002; Payne, 2006). The most important difference is the basic

theory that lies behind dance therapy; namely that there is a powerful connection between

motion and emotion. This principle is grounded in knowledge of child development (Payne,

1990). In therapeutic dance, choreography is used to evoke certain emotions or experiences,

and aesthetic aspects can be of more or less importance, but quality of performance may be an

aim as well. In dance therapy choreography is not seen as beneficial, aesthetics is ignored, and

the aim is never to perform. Instructions may be given in order to promote movement with

different qualities, but the degree of instructions given will in most cases be less than in

therapeutic dance. In dance therapy self-initiated movement and spontaneous interaction is

seen to be the key to explore and enrich the connection between physical and psycho-

emotional factors.

1.3 Aim of the Paper

As mentioned above, there are several different psychotherapeutic techniques that use

dance and/or movement as part of the treatment. This thesis will be narrowed to the concept

of Dance Movement Therapy (DMT), as this is the approach that uses dance in the most

direct manner, including all of the central characteristics of dance (movement, creativity,

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rhythm, intonation). It is also a defined entity and a common term in the United States

(“Dance/Movement Therapy”), and in Great Britain (“Dance Movement Therapy”); and some

research has been done in order to evaluate the effect of this form of treatment. DMT was

developed in the late 1940's (Grönlund, 1991), and is now being practiced with varying extent

worldwide (Capello, 2008). DMT is used in many hospitals and institutions in order to

enhance health in physically (Aktas and Ogce, 2005) and mentally ill patients (Pratt, 2004;

Sandel, 1975), but still the approach is not clear-cut. The required amount of, and type of,

education of the therapist, the structure of the sessions, and the goals for the treatment, varies

a great deal. Research on the area is dominated by explorative, qualitative research, and the

quantitative research that is done is often disturbed by small populations, short duration of

treatment and follow-up, and lack of control over other variables.

The aim of this paper is therefore to explore what the health-enhancing mechanisms in

dance therapy might be, if there are any. DMT is commonly considered to change affect, but

little is known about the processes involved. Possible underlying mechanisms are therefore

presented in a discussion, where the importance of knowledge in this area is emphasized. In

order to narrow the scope of the discussion, one part of the paper will focus on the possible

effect of DMT on affect regulation. Affect regulation is widely assumed to be central to

mental health, and dysregulation is associated with many mental disorders (Gross, 1998). In

sum, the objective of this paper is to investigate if there is any evidence available that dance

as therapy can enhance the ability to regulate affect.

As mentioned above, the field consists of both qualitative and quantitative research.

Qualitative studies are good methods for exploratory purposes, and for creating new

hypothesis. However, for the purpose of evaluating evidence, as is the goal of this paper,

quantitative studies are preferred. Hence, qualitative studies are excluded here. DMT is used

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both as an individual intervention and as a group intervention. There are very few controlled

studies on individual DMT. Therefore, the review will focus on quantitative research on DMT

used as a group intervention.

2.0 Clarification Of Concepts

2.1 Dance Movement Therapy (DMT)

Dance movement therapy is one of the art therapies, seeking to combine the expressive

and creative aspects of dance with the insights of psychotherapy (Stanton-Jones, 1992). In

1998, The American Dance Therapy Association defined Dance Movement Therapy (DMT)

as «the psychotherapeutic use of movement as a process which furthers the emotional,

cognitive, and physical integration of the individual» (Bojner-Horwitz, 1994). The

Association for Dance Movement Therapy UK (ADMT UK) includes social integration too in

their definition of «Dance Movement Psychotherapy», as well as highlighting the role of

creativity. They define DMT as «the psychotherapeutic use of movement and dance through

which a person can engage creatively in a process to further their emotional, cognitive,

physical and social integration» (www.admt.org.uk, 2010).

DMT combines elements such as movement, emotional expression, social interaction,

the use of symbol, metaphor, and narrative (Lumsden, 2006). The creative process of dancing

freely is in itself seen as therapeutic.

Stanton-Jones (1992) have described the main principles of DMT, which mainly

corresponds to what Karkau (2006) found reported in a survey among British DMT therapists.

They can be summed as follows: 1) There is a reciprocal body-mind relationship. How we

move both influences and is influenced by how we feel. In DMT, emotional material is

worked with in parallel to the physical material. Recognition of associations between the

emotional and the physical is encouraged. Feelings can be identified, explored and expressed,

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and pre-verbal experiences can be brought to consciousness. 2) Movement reflects aspects

of personality and unconscious processes. In this context, personality includes

developmental processes, psychopathology, expressions of subjectivity and interpersonal

patterns (Stanton-Jones, 1992) as well as inner conflicts (Siegel, 1995). The patients' feelings,

expressed through movement, provide content and direction for the therapy, rather than the

therapist laying the agenda. 3) Changes in moving facilitate changes in the state of mind.

Spontaneity and creativity enhances self-directed behaviour and choices, and may help relief

habitual effort patterns. Increasing the movement vocabulary, with its corresponding

psychological associations, is seen as facilitating a wider response to the environment (Payne,

1990). Free association in movement is also thought to be inherently therapeutic (Stanton-

Jones, 1992). 4) The client-therapist relationship is essential. This is true for all

psychotherapy, but the way in which the relationship is established might differ. In DMT,

synchronous movement is seen as an important factor in the development of the relationship

(Levy, 1988). In the survey by Karkou (2006) a strong agreement (M = 4.2 on a scale from 1-

5) was found among the respondents of the statement “Active interaction between two people

is a key element for DMT”. In group DMT, interaction between group members is also highly

valued. Different dance styles are used in order to connect with different patients and different

themes, or goals, in the therapy (Grönlund, 1991).

2.2 Regulation of Affect

It is hypothesized that well developed abilities to recognize, reflect on, and express

one's own affect is associated with good mental health (Monsen and Monsen, 2000). These

functions are viewed as necessary in order to achieve and maintain a coherent self.

Information about one’s affects can be used as meaningful information, and a motivating

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force (Tomkins, 1979). If affect is not recognized and used as information, one will not be

able to adapt to the environment in a constructive manner.

The concept of “affect regulation” is part of the broader concept of “self-regulation”,

and can be regarded as “a process involving reciprocal interactions between the

neurophysiological, motor-expressive, and cognitive-experiential domains of emotion

response system” (Taylor, Bagby & Parker, 1997, pp. 14). It includes processes on different

levels, enhancing or decreasing, voluntarily or automatically, any affect experienced –

positive or negative (Gross & Thompson, 2007). “Emotion regulation” is a slightly more

narrow concept, and is defined by Gross (1998) as “how people influence which emotions

they have, when they have them, and how they experience and express them”. For the purpose

of this study, the term “affect regulation” will be used. Emotion regulation is, however, seen

as the most central part of affect regulation, in addition to regulation of mood.

In attachment theory, regulation of affect is assumed to “foster the emergence of self-

regulation from coregulation” (Fonagy, Gyorgy, Jurist & Target, 2004). A link is suggested

between affect regulation and attachment style (Cassidy, 1994), and it has been hypothesized

that dysregulation is linked to psychopathology (Gross, 2007; Slade, 1999). A model has been

presented of how all psychopathology has its origins in affect dysregulation (Bradley, 2003).

It is argued that increasing the ability of affect regulation is one of the common factors

contributing to change in all effective interventions. Different interventions deal with affect

regulation in different ways, of course, but they all seek to improve the patient’s capabilities

to deal constructively with affect. For instance, if one knows how to deal with negative

emotions, one will experience fewer prolonged states of stress, and the risk for

psychopathology is lowered. In psychoanalysis affect regulation is associated with internal

conflict. It is noticed by Fonagy et al. (2004) that in spite of partly different views on affect

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regulation, both psychoanalysis and attachment theory sees affect regulation as a balance

between positive and negative affects.

Children reporting symptoms of depression have been found to also use affect

regulation strategies less, or using less beneficial affect regulating strategies, than non-

depressed children (Garber, Braafladt & Weiss, 1995). The same association is found for

adolescents (Kobak and Ferenz-Gilles, 1995). One of the traits characterizing persons with

borderline personality disorder is emotional lability, and in treatment of these patients,

increasing the ability of affect regulation is seen as an important factor (Fonagy et al.,

2004).This does not necessarily mean that advantageous affect regulating strategies prevents

psychopathology, or that disadvantageous strategies cause it, the associations may be more

complex. However, there seem to be an association. Dysregulation of affect is in fact

indicated in the descriptions of more than half of the axis 1 diagnoses in DSM-IV, and all the

axis 2 diagnoses (Gross and Levenson, 1997). It is therefore reasonable to assume that

increasing affect regulation in patients with various mental problems might decrease their

symptoms.

3.0 Psychological Theories On Movement And Affect

The relationship between movement and emotion is relevant to several areas of psychology.

In social psychology, one is concerned with non-verbal communication, and how this is used

as social information (Aronson, Wilson & Akert, 2007). An important aspect of non-verbal

communication is expression of emotion. Darwin studied facial expressions and hypothesized

that non-verbal communication is “species-specific” and not “culture-specific”. Being able to

communicate one's emotional states, as well as recognizing others' has survival value

(Darwin, 1872).

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It has been stated that “no-where are mind-body interactions more obvious than in the

emotions” (Passer & Smith, 2000, p. 365). An emotional response, triggered by an emotional

stimulus, includes a cognitive component, a physiological component and a behavioral

component. These components are inseparable. Common sense is that we notice how we feel

and then act according to it. James-Lange Theory of Emotion, also known as somatic theory

of emotion (Papanicolaou, 1989) argues, on the other hand, that we know what we feel by

noticing our behavior. Research do in fact show that the latter can be the case in some

situations (Soussignan, 2002), although the different components are now considered to

interact in a reciprocal manner. It is common to think of body posture, facial expression, and

other non-verbal behaviors as consequences of a person's mental state, and so the therapist

works with the mental content, hoping that the non-verbal behavior, and thereby the patient's

appearance, will change along with it. Some theoretical and therapeutic approaches, however,

focus on the idea that the movements, and interactions with one's environment influence

mental development. Some of these, who have had an important influence on the

development of DMT, will be presented briefly.

3.1 Wilhelm Reich and body-focused therapy

Wilhelm Reich expanded Freudian psychoanalysis in radical ways. In “character

analysis” (1972) he describes how resistance towards therapy can appear in form of body

language and physical tension as well as in verbal, spoken, information. He believed

unreleased psychosexual energy could produce physical blockades in muscles and organs.

Through studying the patients' psychosomatic expression, he wanted to reveal muscular

tensions functioning as resistance, and break down what he called the “muscular armor”. He

used breathing, and other techniques in his therapy, to mobilize body energies, and he might

ask patients to change body positions and notice how that felt (Daniel, 2008). Thus, he was

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working on two different levels, both the physical-muscular level and the verbal,

psychoanalytic level Many body-focused therapies conducted today can be traced back to

Reich, and his followers, with Alexander Lowen being the most well-known (Grönlund,

1991). Lowen’s ideas of “bioenergetics” (1988) is a way of understanding personality through

bodily energy and movement. The goal of the therapy is to help the patient to be in contact

with his or her body. In order to achieve this, he used techniques such as breathing,

movement, massage and self-expression. He believed that emotions such as stress, anger, and

anxiety, as well as unconscious conflicts, are reflected in the body language. Awareness of

one’s muscular tensions can increase the patient’s understanding of his or her emotions or

conflicts, and the goal is to relive the suppressed emotions and tensions through movement.

DMT therapists drew inspiration from these ideas.

3.2 Developmental Psychology

Developmental theory has had a strong influence on the development of DMT.

Winnicott highlighted the importance of integrating the psyche and the body in order to

acquire a true self. Play and creativity is seen as vital for a person's well-being, and for the

development of the self (Winnicott, 1971). Stern described a rhythmic dialogue between the

new-born and its caregiver, which is essential in order to develop empathy. Stern was inspired

by research on mirror neurons and imitation, which supported his view of the infant’s

directedness towards intersubjectivity and the necessity for this “binding” to the caregiver for

the child’s emotional development (Hart & Schwartz, 2008). In DMT, the therapist seeks to

create a “holding environment”, or “intersubjetive room” so that the patient is free to explore

and express affect, in the same way as the infant and it's caregiver. The dance is seen as a tool

through which the patient can rediscover his or her “own capacity to imagine and fantasize, to

generate experiences that feel deeply real, personal and meaningful” (Mitchell & Black, 1995,

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p. 134). These experiences are seen as facilitating therapeutic change; just as the infant's

experiences of holding, or binding to the caregiver, facilitate exploration necessary for the

infant's emotional development.

4.0 DMT: Context And Applications

4.1 Art Therapies

«Expressive therapies» is defined by Cathy A. Malchiodi (2005) as «the use of art, music,

dance/movement, drama, poetry/creative writing, play, and sandtray within the context of

psychotherapy, counseling, rehabilitation, or health care». Thus «expressive therapies» is a

slightly wider concept than «creative arts therapies», which according to the National

Coalition of Creative Arts Therapies Associations (2004) only includes art, music,

dance/movement, drama, and poetry/creative writing. What separates art as therapy from art

in general, is whether the focus is on the product, or on the prosess in itself (Dalley, 1984). In

general art the focus is on the product, while in art as therapy the focus is on the process.

The idea of using the arts as treatment is an old one (Malchiodi, 2005). It is said that

the Egyptians, as early as 500 B.C. encouraged people with mental illness to engage in

creative activity, such as attending concerts and dances (Fleshman and Fryrear, 1981). In the

Bible, King Saul claimed finding healing in David’s harp music, and the Greeks used music

and drama “to help the disturbed achieve catharsis, relieve themselves of pent up emotions,

and return to balanced lives” (Gladding, 1985, pp. 2). The “catharsis theory”, however, has

not been supported by empirical evidence, in fact several studies have found contradicting

evidence (Bushman, 2002; Geen & Quanty, 1977; Warren & Kurlychek, 1981). But

regardless of the different theories that was used to explain any effects, it is interesting that

many of the ancient cultures, or their healers, “thought that there were power in the arts”

(Gladding, 1992, pp. 3). In the middle of the 1900’s the term “art therapy” was used by

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several health professionals to describe their work (Malchiodi, 2003). At this time there was a

movement in the field of psychiatry towards giving mental patients a more humane treatment.

Art therapies became an important part of “moral treatment”(Malchodi, 2005).

4.2 The History of DMT

In the beginning of the 20th century, formal dance in the western world was dominated by

classical ballet, which follows a strict regime. Isadora Duncan, Martha Graham and Doris

Humphrey are some of the pioneers of the early modern dance, who valued themes such as

spontaneity, authenticity of expression, and body awareness (Wahlström, 1979). They in turn

inspired Marion Chase, who started to use dance therapeutically in the treatment of

schizophrenic patients. As Sullivan and Fromm-Reichmann's innovative ideas started to

transform traditional psychiatric practice, it became possible to use dance as part of the

treatment (Stanton-Jones, 1992). Marion Chace later founded The American Dance Therapy

Association in 1966. Kristina Stanton-Jones stated that “DMT would have been unthinkable

without the artistic and choreographic ideas that ventred on direct emotional expression and

abandoned formalism” (1992, s. 12). Rudolf Laban was an Hungarian dance artist and theorist

who was especially known for his work in the UK. He categorized movement in a systematic

manner, so that it was possible to use movement observations for assessment and diagnostic

evaluations. His theories led his students and others to promote the use of dance and

movement in therapeutic contexts (Payne, 1990).

In the same time period, there were also new developments in psychotherapy, and

several psychologists showed interest in nonverbal aspects of psychology and

psychopathology. In Darwin's work, “The Expression of the Emotions in Man and Animals”

(1872), the nature of facial and bodily expression was explored from an evolutionary point of

view. Eugen Bleuler in Switzerland, Jean-Martin Charcot in France and Henry Maudsley in

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England observed psychiatric patients' movements and gestures in hope that they would be

able to develop clear diagnostic criteria to predict the course of these patient’s diseases

(Stanton-Jones, 1992). Also other disciplines than psychology, such as anthropology,

linguistics, and social sciences also took up an interest for nonverbal behavior, and the work

in this area has become more specific. The aspect of movement analysis that is taken as a

focus in DMT is the movement's “qualitative, expressive, psychological aspect” (Stanton-

Jones, 1992, p. 60).

Psychoanalytic ideas gained huge popularity in the first half of the twentieth century,

and their ideas also influenced the development of DMT. Especially the notion of the

unconscious material that can be discovered through dreams, free association, or slips-of-

tongue, led dance therapists to hypothesize that dance and movement, as well, can be a “royal

road” to the unconscious (Penfield, 1992). The humanistic psychology movement of the

1950’s and 1960’s also played a part in the development of DMT (Dosamantes-Alperson,

1974), as did new knowledge of group therapy.

Karkou and Sanderson (2000) interviewed dance movement therapists in UK, working

in education (N=16) and elsewhere (N=25). The theoretical influences that was reported by

most therapists was the work of Winnicott, development theories, object relations theory, play

therapy, specific DMT traditions, Bowlby's theory of attachment, Jungian symbol work,

psychoanalytic theory, humanistic approaches, and client-centered therapy. Less important

influences that were reported were specific dance traditions, group analytic theory, integrative

approaches, eclectic approaches, Kleinian theory, Gestalt therapy, and Behavioral therapy.

4.3 Areas of Application

The training on non-verbal attunement is extensive in DMT. Lumsden (2006) argues

that this is exactly what is needed in treatment of patients with complex trauma, where the

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basic affect regulation mechanisms may be deficient. It is also reasonable to assume that

when a person has physical complaints and distress caused by somatic changes, a somatically-

oriented approach to psychotherapy can have a positive impact (Goodill, 2006).

DMT has in fact been used in work with traumatized patients (Gray, 2001;

MacDonald, 2006; Meekums, 1999; Mirro-Finer, 1999; Moore, 2006; Thulin, 1999) and

physical complaints like fibromyalgia and medically unexplained symptoms (Fersh, 1982;

Mannheim & Weis, 2006; Payne, 2009). It has also been used extensively in the work with

elderly patients (Fersh, 1982; Grönlund, 1991; Nyström, 1999; Kindell & Amans, 2003), with

psychotic and schizophrenic patients (Helgesson, 1999; Oganesian, 2008; Xia & Grant,

2010), people with eating disorders (Härkönen, 1999; Krantz, 1999), prison inmates dealing

with violence and addiction issues (Goodison & Schafer, 1999; Milliken, 2008), children and

adults with different kinds of developmental disabilities (Grönlund, 1991; Persson, 1999),

children with behavioral and relational problems (Capello, 2008; Grönlund, 1999), child

survivors of war and torture (Capello, 2008), and also with children in regular education

(Harvey, 1989; Hervey & Kornblum, 2006). In the last 15 years DMT has also been used to

reduce stress and anxiety associated with chronic diseases (Goodil, 2006) and cancer (Cohen

and Walker, 1999; Rainbow, 2005). Because it uses non-verbal interaction it is suggested that

this treatment is especially efficient for patients whose capacity to engage in a strictly verbal

therapy is limited (Sandel and Johnson, 1983).

Not only has DMT been applied to a wide range of areas, but it is also practiced in

several different ways. The treatment can be offered in groups, or in individual sessions. The

psychotherapeutic orientation of the therapist can vary between psychodynamic, Jungian, ego-

psychoanalytic, Gestalt, or humanistic (Stanton-Jones, 1992). Different kinds of dance are

used in the interventions. Improvisation is most common, but other dance styles have been

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used, such as ballroom dance, African dance, modern dance, and circle dance. Also, the

degree of professional training varies among dance movement therapists, as does their way of

structuring the treatment. Most programs include some time at the end of each session to

discuss verbally the experiences the participants have had during the session. Some therapists

value this as an important part of the intervention, contributing to integrate non-verbal

experience with verbal knowledge. However, as there are no known standards for this, it

probably varies how this part of the session is used: what is discussed, for how long, and how

open the participants are encouraged to be. Most dance movement therapists uses a rather

eclectic approach, adjusting the theoretical approach, the dance style, and the program, to the

particular patient(s) and the current goals of the therapy (Grönlund, 1991).

4.4 What Are the Factors in DMT Treatment That Are Assumed to Promote Change?

Several factors are suggested by DMT practitioners to be responsible for positive

changes due to DMT. One such factor is the relationship to the therapist, and the experience

of receiving unconditional positive regard. In DMT, this experience is assumed to be induced

through processes such as synchronous attuning and mirroring (Bunce, 2006). Many DMT

therapists work with transference. Some also point to the containing function of the group,

and the experience of acceptance from the group. Group rhythm, synchrony, and vitalization

is believed to promote change (Schmais, 1985).

Furthermore, it is suggested that DMT help the patients to “create symbols that

represent emotional experiences” (Bojner-Horwitz, Theorell & Anderberg, 2003, pp. 255) and

that this process can bring to consciousness suppressed emotions, and help the patients deal

with these. Expressing emotions is a central part of DMT, and the idea of letting go of

emotional tension through cathartic experience is strong among at least some practitioners

(Bernstein, 1995). The use of catharsis is often thought of as a means to give the patient an

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experience of mastering overwhelming emotions (Baum, 1995). Fletcher (1979) however

admits that releasing negative feelings or tension may, if it is too explosive, further disorient

the patient, instead of the opposite. She therefore states that this process must be followed by

therapeutic work in order to gain insight into these feelings. Verbal processing of the

experiences one has while moving, is seen as a way of integrating verbal and non-verbal

experiences (Levy, 1988).

The idea that movements associated with specific developmental states may evoke

preverbal experiences is held by many practitioners (Karkou, 2006; Kestenberg, 1975; Siegel,

1995), and is in fact supported by research demonstrating how postures congruent with earlier

autobiographic memories facilitated these memories (Dijkstra, Kaschak & Zwaan, 2007). A

widespread principle in DMT work is that changes in movement patterns give new emotional

experiences. Since we know that bodily feedback can influence the mental state (Berrol,

1992; Koch, Holland, Hengstler & Van Knippenberg, 2009; Reisenzein, 1983), it is not

unreasonable to assume that moving in unfamiliar ways may trigger unfamiliar emotions.

It is assumed that a focus inwards will facilitate authenticity and lead to

acknowledgment of ones emotions, and that experiences with awareness and breath promotes

a greater sense of control over the body (Erwin-Grabner et al., 1999;). Achieving greater

control over the body through DMT is assumed to be associated with less helplessness and

anxiety (Bojner-Horwitz, 2004) as well as mastery (Erwin-Grabner, Goodill, Hill, & Neida,

1999; Levy, 1988).

Another way DMT is assumed to benefit patients is through increasing social skills.

The theory is than that DMT gives a better understanding of non-verbal communication,

which will increase social skills (Bunce, 2006). DMT also creates an atmosphere for

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exploration of social interaction (Ritter & Low, 1996). Learning to take initiative and make

choices in a safe environment is assumed to transfer to other arenas in life.

5.0 Research On DMT

Research on dance therapy has mostly been qualitative and exploratory clinical

reports, and in some cases the researcher is also the therapist. In spite of a negative attitude

toward quantitative, empirical research among some dance movement therapists, there is now

an increasing acceptance for the importance of research in the field (Berrol, 2000). Although

there exists a discussion about whether traditional (quantitative) research on DMT is the most

appropriate methodology (Meekums & Payne, 1993), it seems to be widely accepted that

research is crucial for further development of DMT: “Attention to research will allow

dance/movement therapy to play a more prominent role in the multidisciplinary team dance,

and to claim a greater share of health care resources” (Higgins, 2001, p. 195). Indeed,

quantitative research in the area has increased in the last 30 years, and some results are, if not

convincing, promising.

A meta-analysis on the effect of DMT was published by Ritter and Low (1996), where

23 studies were included. Fourteen were between-subjects designs, comparing dance therapy

(DMT) treatment groups with controls, and nine were within-subjects designs, comparing pre-

and post-treatment measures. The authors state that the research on DMT has plenty of

methodological problems. First of all, the within-subject design is problematic, as it does not

control for maturation or specific events, neither for the placebo effect. Also among the

studies that was included in the meta-analysis, three studies (Boswell, 1993; Mattes et al.,

1986; May, Wexler, Salkin & Schoop, 1974) used measures that had unknown reliability and

validity, some did not mention whether participation was voluntary or not, and in some

studies the participants probably received additional treatment. But still, the authors conclude

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that the available research suggests that DMT may be an effective treatment for patients

suffering from a range of symptoms. Specifically, the treatment seems to be effective for

anxiety (r = .70), and the results are more optimistic for adults and adolescents than for

children (r = .29). For measures on changes in self-concept (how the participants viewed

themselves), they found a relatively low effect size (r = .27), and assumes therefore that DMT

in itself does not affect the self-concept. Some of the studies measured effect on body

awareness. The results here indicate a modest effect (r = .34), but are inconclusive, mainly

because several of these studies used projective tests with low reliability (Ritter & Low,

1996).

Cruz and Sabers (1998) identified a problem with Ritter and Low's treatment of effect

sizes that may have underestimated the effect of DMT. They also compared the results of the

meta-analysis to meta-analysis of alternative treatment methods, like cognitive-behavioral

therapy, medical meditation techniques, exercise, and medical treatment, and found that the

range of the results from DMT treatment (effect sizes between .15 and .54) is quite

comparable to other treatment modalities. This led Low and Ritter to publish a letter in

response, taking the methodological problems into consideration and concluding that «both

psychotherapy and DMT appear to produce measurable improvement in participants» (Low &

Ritter, 1998, p. 107). Unfortunately, since 1996 there have been done onlt a few quantitative

studies on DMT. These, plus a few of the studies included in this meta-analysis, will be

reviewed thematically. All studies mentioned in this section is shown in table 1.1.

5.1 Anxiety

The effect of modern dance on anxiety in a healthy population was investigated by

Leste and Rust (1990). This was one of the first studies attempting to control for alternative

causes for improvement, such as physical activity. They compared the effect of attending a

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modern dance group with attending a physical education group, a music group, or a

mathematics group, on anxiety. Thus, the effect of exercise and music, or aesthetic

appreciation, plus the placebo effect of attending a group at all, was controlled for. The

participants (n=84) were students, and the courses were integral parts of their studies. They

were tested with a battery of tests in the fourth week of their first term. Post-testing for

anxiety was done in the middle of the second term. Analysis of variance of the pre-test scores

showed no significant differences between the groups on neither state- or trait-anxiety

measures. On post-test scores they found that anxiety levels in the modern dance group was

reduced significantly, but not in any of the control groups. Since there was only one group in

each category, what one can conclude is only that at least in these specific groups, «effects of

music and physical exercise alone are less than when they are combined in dance» (p. 6).

Also, one can not be sure whether preexisting differences between the groups influenced the

results. The preexisting groups were measured on variables such as sex, age, attitude towards

dance, previous experience with sports, dance, and relaxation, and the results indicated that

the results could not be accounted for by any of these factors. Still, less obvious differences

between the groups might have been influential.

One pilot study investigate the effect of DMT on test anxiety (Erwin-Grabner et al.,

1999). The participants were randomly assigned to intervention group (n=11) or control group

(n=10). They used Test Attitude Inventory (TAI) to measure whether self reported test anxiety

was reduced in the intervention group compared to the control group, and found that it was

reduced significantly (t= -2.01, p= 0.030). However, the control group in this study did not

receive any treatment, so the results does not say anything about DMT treatment compared to

other interventions.

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A few studies on psychiatric patients have also shown reduction in anxiety due to

DMT (Brooks & Stark, 1989; Kline et al., 1977). These were included in the meta-analysis by

Ritter and Low (1996).

5.2 Biological markers and depression

Various outcomes of female fibromyalgia patients receiving DMT were compared

with the outcomes of a control group (Bojner-Horwitz, 2004). The total number of

participants was 36, and they were randomly divided in a target or a control group. The target

group received DMT for six months. For both groups hormonal, emotional, and physical

changes were measured. Biological markers measured were serum concentrations of

hormones (prolactin, dehydroepiandrosterone sulphate, cortisol, and neuropeptide Y) in

plasma and saliva. According to visual analysis and participants’ self-reports, both physical

and psychological function was increased in the target group during these six months and

eight months later. But the groups did not differ significantly in depression as measured with

Montgomery Åsberg Depression Rating Scale (MADRS; Montgomery & Åsberg, 1979), nor

in the hormonal measures. The author suggests that the biological markers measured would

need a longer treatment period for a significant effect to appear, with regard to the long

duration of the participant’s illness. However, this is an interesting study because it is the first

study to include biological markers in the evaluation of outcomes from DMT.

A Korean study also included biological markers in evaluating the effect of DMT on

mild depression in adolescents (Jeong, Hong, Lee & Park, 2005). In addition to self-report

measurement (Symptom Check List; SCL-90-R; Derogatis, 1977), they measured plasma

concentration of cortisol, serotonin and dopamine in a DMT-group (N=20) and a control

group (N=20). Results showed an increase in plasma serotonin concentration and a decrease

in dopamine concentration in the DMT-group, and not in the control group. Cortisol

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concentration did not change significantly in any group. The results of SCL-90-R indicated

improvement in negative symptoms in the DMT-group, and the authors suggest that

modulation of serotonin and dopamine production might be the mechanism responsible for

the reduction in depression. This study has less confounding variables than most research on

DMT, as there were strict exclusion criteria, for example the fact that none of the participants

could receive any parallel treatment. The treatment period was also longer and more frequent

than in most studies. However, as the control group received no treatment, the expectation

effect was not controlled for, as was not the effect of engaging in social activity nor physical

exercise alone.

In another study, a group of depressed, older adults received ballroom dance lessons as

a treatment for geriatric depression (Haboush, Floyd, Caron, LaSota & Alvarez, 2006).

Participants were randomly assigned to an immediate or an delayed treatment group. Parallel

treatment and comorbidity was controlled for. Results showed medium effect sizes for

measures of depression, but the population was too small to detect a significant effect of the

dance lessons. The authors mention being active, engaging in a new activity, and interacting

with others as factors that might have caused the effect. It is noteworthy that in this study

general mental health (as measured by SCL-90) was not increased as much as the measures

specific to depression. This may be because depression was the main problem of the

participants, or it may indicate that such a treatment has a specific effect on depression. They

also found in this study that self-efficacy was a predictor for positive development, while

hopelessness on the other hand predicted worse outcomes.

Classes receiving African dance or Hatha Yoga were compared in terms of changes in

affect and changes in cortisol (West, Otte, Geher, Johnson & Mohr, 2004). Results indicated

that both classes reduced perceived stress and negative affect, as compared to a biology class

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where no change occurred. Further analysis showed that changes in cortisol and changes in

positive affect was negatively correlated in yoga, but positively correlated in African dance.

The participants of this study were already enrolled in their respective classes, which makes it

probable that personality characteristics may have biased the choise of class and therefore the

results. Still, it indicates that different body and movement focused interventions had similar

psychological effects.

Thirty-one psychiatric patients with a main or additional diagnosis of depression was

divided into three groups: a dance group with music, a music-only group, and a movement-

only group (Koch, Morlinghaus and Fuchs, 2007). The latter used ergometer bikes, and the

intensity of the exercise was the same as for the dance group. The dance group with music

showed significantly less depression on the posttest, and significantly more vitality compared

to the music-only group. However, it should be mentioned that dancing was not the only

factor exclusive to the intervention group. The intervention group included more interaction

with the rest of the group and more of a cognitive challenge than did the control groups,

factors that might have affected the results. However, these factors are integral parts of DMT

and can hardly be excluded.

Two pilot studies carried out by Kuettel (1982) showed that attendants in a single

dance therapy session reported to experience more affect than did participants in a control

group participating in regular student activities, and participants receiving group therapy.

More confidence was reported, as well as less feelings of depression and anxiety, but also

more feelings of inhibition, anger and somatic distress.

It can also be added here that Koch (2006) reported from the 2nd International

Research Colloquium in Dance Therapy, findings by Gunther and Hölter (2006). This was an

evaluation of an intensive DMT treatment for 2-3 months with 45 depressed patients, and

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positive results are reported on the dimensions of movement and well-being, body- and self-

perception, perception of relationships, and perception of one's biography. Details, however,

unfortunately are not available as there is no known English publication of this evaluation.

5.3 Psychosis

Even though descriptive studies claim to have found improvements in hospitalized

psychiatric patients due to DMT (Chace, 1953; Heber, 1993; Sandel, 1975), quantitative,

controlled studies have not given the same results. Much of the research on psychiatric

patients build on tests in which reliability and validity is not well documented, and are

afflicted with confounding variables such as parallel treatments, medication, and

heterogeneity of diagnoses, which perhaps can partly explain the results (Ritter & Low,

1996).

Brooks and Stark (1989) found statistically significant changes in depression and

anxiety, as measured by Multiple Affect Adjective Check List (MAACL; Zuckerman &

Lubin, 1965) in a group of psychiatric inpatients after a single session of DMT, compared to a

no-treatment control group. This indicates possible psychological effects, at least temporarily,

in psychiatric patients.

The mentioned meta-study by Ritter and Low (1996) included two quantitative studies

evaluating the effect of DMT for schizophrenic patients. One of them, (Christup, 1974), had a

population of 54 and included a control group, but used tests relying on human figure

drawings (the Goodenough Scale and the Swensen Sexual Differentiation Scale) whose

reliability are not very well documented (Weiner, 1966). Between-group comparisons were

not statistically significant. The second study (May et al., 1974) used interview-based ratings

by psychiatrists and nurses, and compared outcomes in the DMT group with outcomes in a

music therapy group. This study, including 38 subjects, did not indicate improvements due to

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DMT. A Cochrane review on dance therapy on schizophrenia was carried out recently (Xia &

Grant, 2010), and found no evidence to neither support nor refute the effect of dance therapy

with schizophrenic patients. The data were inconclusive due to a small sample.

5.4 Physical Measures

Some studies have indicated positive physical effects of DMT. One study evaluated

the effect of DMT on patients with Parkinson's disease, and found improvements in speed of

walking in the treatment group, but not in the exercise group which was used as a control

group (Westbrook & McKibben, 1989).

A increased range of motion due to DMT is found in patients with rheumatoid arthritis

(VanDeusen & Harlowe, 1987). This study compared the DMT program (n=17) to a

traditional exercise and rest program (n=16) and did a follow-up four months after ended

treatment. The results showed significant differences between the groups in favor of the DMT

group on upper extremity range of motion on the follow-up, although the frequency of

exercise was higher in the control group. Another study (n=107) also used a treatment-as-

usual group as control group (Berrol, Ooi & Katz, 1997), and found indications that elderly

with neurotrauma benefited from DMT, in terms of statistically significant improvement (p=

< .05) on some aspects of physical function (such as balance while walking sideways and

backwards, and one item measuring range of motion), but not in other aspects (such as spatial

orientation, motor planning, and reaction time). A study with visually impaired children

demonstrated significant improvement in muscle control, balance, and spatial awareness

(Chin, 1988); and children with mental retardation was shown to have a significant increase in

dynamic balance skills after 12 weeks of DMT compared to a traditional gross motor program

(Boswell, 1993). However, a study with mentally retarded children indicated no improvement

on motor performance, body awareness, or self-concept (Kavaler, 1974). The failure to

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demonstrate significant changes in this study may possibly have been influenced by a

“ceiling effect” (Ritter & Low, 1996).

Survivors of breast cancer were given a 12 weeks DMT intervention in order to

determine its effect on life quality and shoulder function in this population (Sandel et al.,

2005). A waiting list group served as control group, and there was a crossover after 12 weeks

so that the control group received the same 12-week intervention from week 14 to 25. Both

groups were tested in week 1, 13 and 26. The intervention group showed a significant

increase in a breast-cancer-related measure of quality of life (Functional Assessment of

Cancer Therapy – Breast Cancer; Brady et al., 1997) compared to the wait list control group,

as well as 7° greater shoulder range of movement (ROM) than the control group. Statistical

significance of the change in shoulder ROM could not be determined due to large variability.

Similar improvements were found for the control group at the crossover period. At week 26,

the intervention group maintained the high scores on the quality of life measure, which

indicated a lasting effect. The authors still rise the question of why the improvement

happened: to what degree the effect was due to actual movement, to music, to the discussion

after each session, to expectations, or to having an enjoyable experience and a feeling of

participation. There is no way to determine which factors are of more importance in this study

and which are of less. This is a general problem which will be elaborated in a later section of

this paper.

A Cochrane review on «Dance movement therapy for improving psychological and

physical outcomes in cancer patients» is still on protocol stage, and will be published later this

year.

5.5 DMT with Children

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Research on children with mental retardation (Boswell, 1993; Kavaler, 1974), visual

impairment (Chin, 1988), and a study with depressed adolescents (Jeong et al., 2005) are

reviewed above. The results from the studies with children with mental retardation indicated

respectively, some improvement in dynamic balance skills (Boswell, 1993), and no significant

improvements in motor performance, body-awareness, or self-concept (Kavaler, 1974). The

study on visual impairment found significant improvements on muscle control, balance, and

spatial awareness. The study with depressed adolescents (Jeong et al., 2005) found changes in

serotonin and dopamine concentration due to DMT, as well as a decrease in symptoms of

depression, as measured by SCL-90-R. A study of eleven children with varying

psychological and physical disturbances (Wisloshi, 1981) was included in the meta-study by

Ritter and Low (1996). Significant changes in attention, participation, and relaxation, was

found. Though, it is noted that the reliability of the measurement used is not reported.

Some more recent research has focused on DMT programs incorporated in schools.

Two studies of which include 56 and 54 children respectively, will be reviewed here. The first

is an evaluation of a DMT program designed to prevent aggression among children:

“Disarming the Playground” (Kornblum, 2002). It was evaluated in a controlled study

(Hervey & Kornblum, 2006) including second grade students with a high percentage of “at

risk children”, and children with special needs. As this is a practice-based evaluation, it

studied the program as it actually was implemented, and did not select random samples. This

means that a lot of environmental factors was not controlled for. But the results, however, can

be said to be more generalizable to programs implemented in similar school systems. The

children were assessed with Behavior Rating Index for Children (BRIC; Stiffman, Orme,

Evans, Feldman & Keeney, 1984) at the beginning and in the end of the school year. Results

showed statistically significant changes in the scores of 87.5% of the children, where 76.79%

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of these changes refer to decreases in problematic behaviors. However, this was a specially

designed program for preventing, or decreasing aggression, and the children was taught

specific skills of how to deal with upsetting situations. Their parents also received monthly

letters so that the children could practice the skills at home. Due to the lack of control groups,

it is especially difficult to know whether the improvement in behavior was influenced by the

dance and movement, or by the explicit presentation of skills, the school's focus on aggression

prevention and rehearsal of the skills at home.

The second violence prevention program, called PEACE, was evaluated by Koshland,

Wilson, and Wittaker (2004). This was a 12-week DMT-based program focusing on

socialization and problem solving experiences. In addition to movement, children's stories and

discussions were also used in order to introduce pro-social behaviors. 1st, 2nd and 3rd

graders, who received DMT, was found to have a greater decrease in aggressive incidents

than did 4th, 5th and 6th graders, who did not receive DMT. The fact that the control subjects

was not in the same age group is problematic because one can not know whether younger

children simply change more because they are more susceptible to change. Another weakness

of the evaluation of the two programs is the fact that the teachers were not blind to the

hypothesis, as everyone knew that the programs were directed at reducing aggression. One

can imagine changes in the way the teachers behaved towards the children, as they perhaps

were aware of the importance of reducing aggression. Perhaps the changes can even be

attributed to the “Rosenthal effect”: The greater expectations to the students, the greater they

perform.

A pilot study (Meekums, 2008) was designed to study the effect of individual DMT

with children on “emotional literacy” (EL), which in this study was used as a collective term

for the following aspects: Expression of emotions, self-esteem, and social function. The

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author found that each child (N=6) had increased skills in at least one of the three aspects. As

this was a pilot study with only a small sample and many methodological weaknesses, no

conclusions can be drawn from it.

5.6 DMT in Geriatric Care

107 elderly patients with non-progressive neurotrauma received either DMT, or treatment as

usual (Berrol et al., 1997). In addition to certain aspects of improved physical functions

(reviewed above), the results also indicated improvements due to DMT in cognition, as

measured by Cognitive Performance Scale (CPS), and in social interaction, as measured by

part of the Minimal Data Set (MDS). No improvements in depression were found, but as

clinical depression was non-existent in the majority of the participants, the measure used for

depression, Geriatric Depression Scale (GDS), was probably not a relevant measure.

Another study (Hokkanen et al., 2008) revealed small, but significant improvements in

the scores of Mini-Mental State Examination (MMSM; Folstein, Folstein & McHugh, 1975),

measuring cognitive status, as well as some improvements in self-care abilities, among

patients with dementia. This study included random recruiting from a nursing home, random

assignment into treatment or control group, double baseline, and a follow-up. The treatment

group also improved significantly at post testing in a task of visuospatial ability and planning,

but not at follow up. Changes in memory were not detected. The authors conclude that the

changes were small, but having effect on cognition and self-care abilities, DMT should be

considered as a treatment option in treating dementia.

Patients with Parkinson’s disease (PD) were recruited from a treatment center, and

received either tango or physical exercise classes (Hackney, 2007). Healthy individuals in the

same age group receiving the same intervention, namely tango or physical exercise, were used

as controls. After 20 sessions, statistically significant differences were found between those

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with PD in the tango group and those with PD in the exercise group, with those in the tango

group showing more improvements in measures of falls, gait, and balance confidence.

5.7 Body Awareness, Body Image, and Self-Esteem

Body image is assumed to be shaped by representation of physical appearance and

bodily experience, and thereby closely related to self-esteem (Lewis & Scannell, 1995).

Movement is seen as relevant because, as one moves, shifts in body perception occurs, and it

gives information about the relationship between different body parts (Schilder, 1950).

Statistically significant differences were found in measures of “body scheme” between a

treatment group and a non-treatment group consisting of elderly patients with neurotrauma

(Berrol et al., 1997). The authors explain the concept “body scheme” as “an internal map of

the body or the inner awareness of the body parts and how they move” (p. 144), and the

concept is measured by the following items: Tactile Localization, Body part awareness,

imitation of postures and identification of body parts. Several other studies suggest

improvements in body awareness (McCarthy, 1973; Ohwaki, 1976) but none of them

included control groups.

In a study with mentally retarded youth (Franklin, 1979) results indicated more

improvement in body image among subjects in a DMT group than in a physical education

group. Van Deusen & Harlowe (1987) compared outcomes from a DMT group with outcomes

from a treatment-as-usual group, and found that the DMT group improved significantly more

than the control group in terms of body image. Silver (1981) found evidence that participants

saw their bodies as more graceful, fast, active, strong, and beautiful after participating in

DMT. Changes in self-concept have also been measured among forensic psychiatric patients

(McConnell, 1988) where a low effect size was found; and among alcoholic women (Reiland,

1990), where effect size was high, but the population very small (N=3). Many of the studies

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on body image mentioned above (Franklin, 1979; McCarthy, 1973; McConnell, 1988;

Ohwaki, 1976; Reiland, 1990) used projective tests, which according to Ritter and Low

(1996) “often produce non-significant results due to individual variability and low reliability”

(p. 257). Another study failed to statistically differentiate between changes in treatment group

and control group, as both groups had an improvement in body image (Sandel et al., 2005).

The subjects were cancer patients who, at least one month earlier, had undergone breast

surgery. The improvement could strictly be due to post-surgery recovery.

Questionnaires were given to 112 women who had participated in creative dance

movement courses for periods ranging from two weeks to 16.5 years (Lewis & Scannell,

1995). The women who had participated for five years or more, reported being more satisfied

with their bodies and appearance than were the women who had participated for less than five

years. There were no differences between the groups with respect to physical exercise other

than dance, and differences in Body Mass Indices were not found to be clinically significant.

Still, one cannot exclude the possibility that the more experienced group felt better about

themselves initially. The study implies therefore nothing about cause and effect, or about the

direction of the association.

Self-esteem, as measured with Rosenberg Self-Esteem Scale, was found to increase in

a group of cancer patients during 6 weeks of DMT treatment (Ho, 2005). The effect size for

self esteem was estimated as medium (.46), but no statistical significance was found, probably

due to a small sample.

The related concept of “self-actualization” was operationalized by six aspects: inner-

directedness, existentiality, feeling reactivity, spontaneity, self-acceptance and capacity for

intimate contact (Dosamantes-Alperson and Merrill, 1980) and measured by Personal

Orientation Inventory (POI: Shostrom, 196 6). Results showed that the two experimental

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39

groups differed significantly on all six scales from the control groups, which consisted of a

ballet group and a waiting list group. As the participants were students who volunteered for

the project, there may be a self selection bias. However, the waiting list control group would

control for that. Likewise, the ballet class control group would control for the effect of simply

being part of a group, and of physical exercise. The fact that these two control groups did not

differ significantly on either pre-test or post-test scores, as neither did the two experimental

groups, increases the credibility of the results, which indicated increased self-actualization

due to DMT.

6.0 Discussion

This paper has presented relevant research on DMT. It will now attempt to sum up

thematically the implications of the presented studies, as well as the main tendencies in the

different areas of research. Some suggestions for further research will be included.

6.1 What Does Available Evidence Suggest about Effects of DMT?

Quantitative research yields a possible effect of DMT on anxiety. But how effective

this intervention is compared to other interventions or treatment methods remains unclear.

Some results for depression gives room for optimism, but they are not unambiguous.

Many of the studies on depression does not control for the effect of physical exercise and

engagement in a social activity, which both may be influencing mood. These factors are

inherent parts of DMT, and it can be argued that isolating them makes no sense, as the

purpose is to measure the effect of DMT as a integrated whole. The problem with not

controlling for them is, however, that the same factors are also inherent in other activities, like

regular dance or exercise classes. Therefore, controlling for these factors makes it possible to

determine whether subjects benefit significantly more from DMT than they would from any

group activity including physical activity. Some studies also failed to control for self-selection

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bias, which means that the effect could be connected to preexisting characteristics in the

participants. For instance, one study (Haboush et al., 2006) found indications of self-efficacy

as a predictor of DMT treatment effectiveness. Further research could establish whether self-

efficacy, or other factors such as motivation, are required in order for the treatment to be

effective. Excluding self-selection bias is a problem for most psychotherapy research, as

random sampling is both difficult to carry out, and includes ethical concerns.

There are some indications in the literature that hospitalized psychiatric patients can

benefit from DMT in terms of group cohesion, release of depression or anxiety, or decrease of

isolation. However, only a few studies have investigated specific groups of psychiatric

patients. There are up till now no convincing evidence of symptom release for psychotic or

schizophrenic patients.

When it comes to physical improvements due to DMT, positive results are found for

specific aspects of physical functioning in specific patients groups. Other physical functions

have not been found to improve. The positive findings therefore need to be scrutinized by

testing the same specific function in several groups, or in larger samples, in order to check

these results and be able to draw conclusions from them.

Research do offer some support for multimodal interventions, including DMT-based

programs, for aggression-prevention in schools, but these are not yet compared to other

aggression prevention programs. DMT among children with physical disabilities indicate

some improvement in some aspects of physical functioning, but not in other aspects. Studies

including children with psychiatric disorders have hardly been carried out at all.

Results from research on DMT in geriatric care indicate a small effect on cognitive

functions, and possibly on social interaction and self-care abilities. One study (Hackney et al.,

2007) also indicated physical improvements in patients with Parkinson's disease after

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41

receiving tango classes. If future studies strengthen the results from these studies and other

studies, DMT may be seen as an appropriate intervention in populations of elderly patients

suffering from both physical and cognitive impairments.

There are also some evidence that DMT can promote a better body awareness, or a

more realistic body image, in some patients. But the results in this area are mixed. Probably,

better standardization of tests used in this research, as well as proper control groups, would

make it easier to draw conclusions about the effect of DMT on body awareness and body

image.

The majority of the research on DMT regarding anxiety-reduction included in this

paper, have studied reasonably well-functioning individuals, like students, who probably had

few additional problems (Erwin-Grabner et al., 1999; Kuettel, 1982; Leste & Rust, 1990);

while most of the studies on body image used populations with psychiatric (Apter et al.,

McCarthy, 1973) or physical (Sandel et al., 2005; VanDeusen & Harlowe, 1987) diseases.

The studies regarding anxiety found mainly positive results, while the studies regarding body

image found mixed results. One explanation for this may be that positive results are easier to

obtain in populations with more resources and less complex symptomatology.

6.1.1 Evaluation

In sum, it seems that DMT might contribute to reduce anxiety, decrease symptoms of

depression, and enhance a feeling of well-being in participants. These effects are best

documented with respect to relatively well-functioning adults and youths. There are some

indications that the same effects may be present in populations with hospitalized, psychiatric

patients, but evidence of DMT releasing symptoms of psychosis or other psychiatric disorders

does not exist. DMT may also possibly enhance some aspects of physical functioning in

various patient groups. The results regarding body awareness, body image and self esteem are

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mixed, but gives reason to further research. Likewise, research on the effects of DMT on

children are unclear. A few well designed studies indicate that DMT may improve cognitive

function in elderly patients.

6.2. What Factors in DMT can be Assumed to Cause Effects?

As stated above, dance therapy seems to have an effect on mental health at least in a

few circumstances. This paper already presented factors which are believed by DMT

practitioners to cause positive effects, such as: the relationship to the therapist, receiving

unconditional positive regard, the containing function of the group, group synchrony,

processes bringing to consciousness suppressed emotions, letting go of emotional tension,

verbal processing of non-verbal experiences, movements causing new emotional experiences,

focus inward, greater control over the body, experiencing mastery, and having increased

social skills. There is consensus about some theoretical perspectives, while others are more

speculative. But few of these are directly tested through research. However, many of the

mentioned factors are difficult to investigate scientifically. The lack of proper

operationalizations for some of these concepts makes quantitative studies almost impossible.

Some of the concepts are also difficult to study qualitatively, as questioning people would

influence how they respond. This may explain the lack of correspondence between factors

believed to be therapeutic, and the factors that have actually been scientifically investigated.

Two of the factors just mentioned is studied with regard to psychotherapy and

psychological interventions in general. This is the patient-therapist relationship and the

experience of mastery. In addition to these two factors, a few other factors seems essential to

look into, as they are assumed to have positive health effects in other areas than DMT. These

are exercise, music, the use of creativity, and group cohesion. It is essential to establish

whether the effect of DMT is to be attributed to any of these mechanisms alone, or to the

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43

specific combination of mechanisms that possibly exists only in DMT. Knowledge about

these matters is necessary to be able to recommend DMT as an effective treatment or not. To

attain better knowledge about the contributing factors, is also crucial. For example, if exercise

intensity is an important predictor of effect, one should increase the focus on physical

exercise. If group cohesion is an important predictor, commitment to a group should be

stressed and perhaps more focus should be put on the composition of the group. If the effect

of DMT is not greater than the effect of any of these factors mentioned, DMT cannot be

recommend over other interventions including the same factors, for instance regular dance

classes, other forms of exercise, or group activities. However, if the total effect of DMT is

greater than the effect of these factors mentioned, there is reason to believe that this treatment

technique is a valuable supplement, or alternative, to traditional treatment for certain people.

6.2.1 Exercise

Some of the studies reviewed above did control for the effect of physical exercise

(Apter et al., 1978; Dosamantes-Alperson & Merrill, 1980; Franklin, 1979; Koch et al., 2007;

Leste & Rust, 1990; Westbrook & Mc Kibben, 1989). As reported above, Apter et al., (1978)

and Franklin (1979) found statistically significant differences between the DMT groups and

the physical education groups on body image, with the DMT groups achieving more positive

outcomes. In a more recent study (Koch et al. 2007), less depression was found in the DMT

group than in the physical exercise group. A modern dance class was found to have more

effect on anxiety than a physical exercise class (Leste & Rust, 1990), and a DMT group was

reported to gain increased reactivity to their own feelings compared to a ballet class

(Dosamantes-Alperson & Merrill, 1989). Westbrook & Mc Kibben (1989) used a crossover

design, and found that patients with Parkinson's disease increased walking speed more after a

DMT program than after simply exercising.

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In total, it appears that physical exercise is not the single mechanism at work in DMT.

Physical exercise alone cannot be said to explain the effect DMT appears to have on anxiety,

depression, and reactivity to feelings. A focus on emotional aspects, which is present in

modern dance, but mostly absent in ballet classes, seems to have a positive influence on the

outcomes. As mentioned in the introduction, physical activity have a documented effect on

mental health (Byrne & Byrne, 1993; Lane, 2001; Ommundsen, 2000; Stathopoulou et al.,

2006; Taylor, 2006) Physical activity can therefore not be excluded as a factor contributing,

or partly causing, the positive effects reported from DMT.

6.2.2 Music

The effect of music was controlled for in three studies (Koch et al., 2007; Leste &

Rust, 1990; May et al., 1974). The first (Koch et al., 2007), reported less depression and more

vitality in the DMT group than in the music group. The second (Leste & Rust, 1990), reported

reduction in anxiety in a DMT group compared to a music group, including aesthetic

sensitivity training. But the music group consisted only of 7 participants, whereas the dance

group had 23, and the standard deviation was relatively large, so final conclusions cannot be

drawn. Only one study (May et al., 1974) compared DMT with music therapy, and found

some effect, but no significant differences between these groups. But since both music and

dance therapy include music the effect could possibly be due to music alone. Trevarthen and

Malloch (2000) argue that music and dance works through the same mechanisms, namely by

enabling non-verbal engagement with the world and other people, evoking sympathy and

promoting intersubjectivity:

We believe that music is therapeutic because it attunes to the essential efforts that the

mind makes to regulate the body, both in its inner neurochemical, hormonal and

metabolic processes, and in its purposeful engagements with the objects of the world,

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and with other people. Music, with dance and all the expressive arts, offers a direct

way of engaging the human need to be sympathised with – to have what is going on

inside appreciated intuitively by another who may give aid and encouragement. (p.)

Studies of DMT with and without music would help determine the role of playing

music in therapy, but musicality will always be a part of dance and can therefore not

be excluded, or controlled for. (p.11)

6.2.3 Creativity

Except from the study comparing DMT with music therapy (May et al. 1974), no

studies use other creative activities as control groups. Whether expressing creativity in other

ways, such as through designing, painting, acting, constructing, or writing would have the

same effect, is not known.

6.2.4 Group cohesion and relationship to the therapist

Relationship to the therapist is seen as one of the main factors causing therapeutic

change in psychotherapy (Lambert & Barley, 2001). Group cohesion in group psychotherapy

can be seen as the analogue to the good client-therapist relationship in individual therapy

(Braaten, 1991). It denotes a supportive environment where self-disclosure is made possible

by an empathic, listening, and accepting group offering feedback and seeking to achieve

certain goals.

Some studies compared outcomes from groups receiving DMT with outcomes from

groups receiving treatment as usual (Berrol et al., 1997; Boswell, 1993; VanDeusen &

Harlowe, 1987). In these cases, treatment as usual was motor programs or different activity

groups, and the relationship to the trainer, coach, therapist, or group is not known. One study

used controls receiving traditional group therapy (Kuettel, 1982), but only for one session.

The results indicated fewer feelings of anxiety and depression, more feelings of affection and

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confidence, but also more somatic distress, in the DMT group than in the group receiving

group therapy. But as this was only a single session, it must be seen as a measure of

immediate effects rather than the process of change. What it controls for is not a long term

relationship or group cohesion developed over time, but rather the feeling of social

engagement and participation in any group. One can argue that if group cohesion or

relationship to the therapist was the main factor contributing to change, one should see more

positive results in the studies with a long duration of intervention than the studies of short

duration programs. The fact that some studies show significant changes after only a short term

intervention (Erwin-Grabner et al., 1999) or a single session with DMT (Brooks & Stark,

1989; Koch et al., 2007; Kuettel, 1982; West et al., 2004), may be seen as indication that

group cohesion or relationship to the therapist is not the only factor promoting change. On the

other side, meeting other people and a supportive therapist, and experiencing to be accepted

as part of a group, might have an effect already in the fist session.

6.2.5 Other factors suggested

One of the studies discussed above (Koch et al., 2007) builds on recent research

indicating that both currently and formerly depressed patients show less vertical movement,

than those who has never been clinically depressed (Michalak, Troj, Schulte & Heidenreich,

2006), and suggests that a specific effect of dance on depression may be stimulation of this

missing aspect of their movement repertoire. Their intervention is therefore designed to

increase movement in the vertical dimension. As reported above, the results do in fact indicate

an improvement, but several factors apart from vertical movements may be responsible for

this change. However, it is suggested here that specific movements, or the nature of the

movements performed, are responsible for a positive effect on depression.

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A feeling of accomplishment or mastery is suggested, by one author (Bartholomew,

2002), to be responsible for positive outcomes from aerobic dance, since he did not find

outcomes to vary with exercise intensity. Mastery is also assumed to be as a underlying

mechanism in the study by Erwin-Grabner et al. (1999), as DMT, specifically directed

towards increasing feelings of self-efficacy and mastery, was found to reduce test anxiety.

To sum up, as in psychotherapy research in general, to find out how change happens is

extremely difficult, and such research has both ethical and methodological difficulties to

overcome. There is still a need for research to explore whether a theory, normally used in a

different setting, can be transferred to a DMT setting. For example; does DMT lead to

feelings of mastery? Does it lead to better understanding of non-verbal communication? Is the

relationship to the therapist as essential in DMT as in verbal psychotherapy? Does moving in

unfamiliar ways increase a person's emotional register? And if so, is this associated with

positive changes? Does a person who learns to take more initiative in a DMT setting start

taking more initiative in other arenas of life as well? Such questions could be answered

through carefully designed studies.

6.3 Is there Any Evidence to Support the Notion that DMT can Affect Affect

Regulation?

As discussed above, a number of mechanisms may be responsible for the health-

enhancing effects, however small, reported in some studies on DMT. But are these direct

effects, or do they work in a more indirect manner? How and why should these factors lead to

better health in persons with widely different problems? As it is difficult to single out one

mechanism which alone is responsible for all positive changes, it is reasonable to assume that

several factors work together. One possibility is that the various factors are combined so that

one factor adds to another, and the total outcome is better than if the intervention only

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48

included one of these factors. Another possibility is that several factors, with no effect when

isolated, interact, and that it is only the combination of these factors which is effective.

Expression of affect is of central concern in DMT, and DMT is assumed to influence,

or change, affect (Kuettel, 1982). Differentiation, integration, and regulation of feelings are

identified as central themes in DMT programs and interventions (Berrol et al., 1997; Bojner-

Horwitz, 2004; Jeong et al., 2005; Koshland et al., 2004), as it is in many forms of

psychotherapy. Some therapists have claimed that DMT will lead to increased reactivity to

one's own feelings and greater expression of emotions (Dosamantes-Alperson & Merrill,

1974), as well as an increased physical and emotional integration (Fletcher, 1979). These are

both aspects of affect regulation.

In spite of this being a central concern, there are only very few studies measuring the

effect of DMT on various abilities related to regulating and dealing with affect. The pilot

study by Meekums (2008), on the effect of individual DMT with children on emotional

literacy (EL), indicated some improvements in skills such as expression of emotions, self-

esteem, and social function. This study has an interesting objective, but should be carried out

on a larger scale in order to offer any credible results. In the two pilot studies carried out by

Kuettel (1982) the attendants reported to experience more affect than did those in the control

group and those receiving group therapy. Those in the dance therapy group reported

somewhat less feelings of depression and anxiety, and somewhat more feelings of confidence,

affection, erotized affection, but also more somatic distress, anger, and inhibition. It seems

odd that the same group reported both more feelings of confidence as well as more feelings of

inhibition and distress. But it may indicate that dance therapy enhance the tendency in

subjects to either experience, report, or detect certain affects. It is reasonable to ask whether

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or not expression of affect really is beneficial. Were the subjects better off recognizing their

anger? Or perhaps it would have been better not to be aware of these negative feelings?

The study on the effect of DMT on self-actualization (Dosamantes-Alperson and

Merrill, 1980) is also interesting in the context of affect regulation. Self-actualization is

operationalized by six aspects, and several of these has to do with regulation of affect: Inner-

directedness, existentiality, feeling reactivity, spontaneity, self-acceptance and capacity for

intimate contact. The authors actually conclude that the movement therapy both increased the

subjects' sensitivity to their own feelings as well as their ability to express them.

An area where affect regulation seems of obvious importance is among children with

behavioral problems. The evaluation of Kornblum's program for aggression prevention in

schools (Hervey & Kornblum, 2006), described in section 4.5, also included qualitative

interviews. The authors suggest, on the basis of these, that one of the positive outcomes of the

intervention, not specifically measured quantitatively, was more effective emotional self-

regulation. Children reported becoming less mad, calming down, or being in a better mood

after the intervention.

More research is needed in order to establish whether DMT may increase the ability to

regulate affect. Still, these few studies suggest that this may be the case, and justifies further

exploration. A more adaptive affect regulation would than be a possible mechanism through

which DMT could enhance mental health. As dysregulation of affect is central to a range of

mental disorders, a treatment that is supported by research to have an effect on this particular

ability would have a broad field of application. In addition to people with mental disorders,

the treatment could also be relevant to healthy individuals who want to develop their

personality, or enhance their “self-actualization” (Dosamantes-Alperson and Merrill, 1980).

7.0 Conclusion

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DMT seems to have some positive effects on health for certain groups of people. It is possible

that for some patients or clients, the combination of factors in group DMT, like group

cohesion, musicality, physical activity, relationship to the therapist, and expression of

creativity, has a total benefit which is greater than the effect of one, or a few, of these factors

alone. It may be argued that some positive effects should be expected, since group DMT

combines several factors that have shown effective in other contexts. If one factor adds to

another, group DMT may be one of several ways to combine these efficient factors and affect

health in a positive manner. Another option is that the effect of DMT is not caused by

combining several factors that are common in a wide array of treatments, but that DMT offers

a qualitatively different way of treating patients. However, more research is needed in order to

assess both if, and why this widely defined form of treatment may result in therapeutic

changes.

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8.0 References

Achterberg, J. (1985). Imagery in healing : shamanism and modern medicine. Boston:

Shambhala Publications.

Addington, J., & Addington, D. (1998). Facial affect recognition and information processing

in schizophrenia and bipolar disorder. Schizophrenia Research, 32(3), 171-181.

ADMT UK (2003). Retrieved 30.08, 2010, from http://www.admt.org.uk/whatis.html

Aktas, G., & Ogce, F. (2005). Dance as a Therapy for Cancer Prevention. Asian Pacific

Journal of Cancer Prevention, 6, 408-411.

Apter, A., Sharir, I., Tyano, S., & Wijsenbeck, H. (1978). Movement therapy with psychotic

adolescents. British Journal of Medical Psychology, 51, 155-I 59.

Aronson, E., Wilson, T. D., & Akert, R. M. (2007). Social Psychology (6 ed.). Upper Saddle

River, NJ: Pearson Education.

Bartholomew, J. B. & Miller, B. M. (2002). Affective responses to an aerobic dance class:

The impact of perceived performance. Research Quarterly for Exercise and Sport, 73,

301-309.

Baum, E. Z. (1995). Multiple Personality Disorder: A group movement therapy approach. In

F. J. Levy, J. P. Fried & F. Leventhal (Eds.), Dance and other expressive art

therapies: when words are not enough (pp. 83-92). New York, NY: Routledge.

Berg, A. L. (2009). Affect-focused Body Psychotherapy for patients with Generalized Anxiety

Disorder. Ph.D. Thesis, Karolinska Institutet, Stockholm.

Bernstein, B. (1995). Dance beyond Trauma: Woman survivors of sexual abuse. In J. P. F.

Fran J. Levy, Fern Leventhal (Ed.), Dance and other expressive art therapies: when

words are not enough (pp. 41-58). New York, NY: Routledge.

DANCE AS THERAPY

52

Berrol, C. F. (1992). The neurophysiologic basis of the mind-body connection in

dance/movement therapy American Journal of Dance Therapy, 14(1), 19-29.

Berrol, C. F. (2000). The spectrum of research options in dance/movement therapy. American

Journal of Dance Therapy, 22(1), 29-46.

Berrol, C. F., Ooi, W. L., & Katz, S. S. (1997). Dance/movement therapy with older adults

who have sustained neurological insult: A demonstration project. American Journal of

Dance Therapy, 19(2), 135-160.

Bojner-Horwitz, E., Theorell, T. & Anderberg, U. M. (2003): Dance/movement therapy and

changes in stress-related hormones: a study of fibromyalgia patients with video

interpretation. The Arts in Psychotherapy, 30. 255-264.

Bojner-Horwitz, E. (2004). Dance/movement therapy in fibromyalgia patients: aspects and

consequences of verbal, visual and hormonal analysis. Unpublished Dissertation, Acta

Universitatis Upsaliensis, Uppsala.

Boswell, B. (1993). Effects of movement sequences and creative dance on balance of children

with mental retardation. Perceptual and Motor Skills, 77, 1290.

Bradley, S. J. (2003). Affect regulation and the development of psychopathology. New

York/London: The Guilford Press.

Brady, M. J., Cella, D. F., Mo, F., Bonomi, A. E., Tulsky, D. S., Lloyd, S. R., et al. (1997).

Reliability and validity of the Functional Assessment of Cancer Therapy - Breast

quality-of-life instrument. Journal of Clinical Oncology, 15, 974-986.

Brooks, D., & Stark, A. (1989). The effects of dance/movement therapy on affect: A pilot

study. American Journal of Dance Therapy, 11(2), 101-112.

Braaten, L. J. (1991). Group cohesion: A new multidimentional model. GROUP, 15(1), 39-

55.

DANCE AS THERAPY

53

Bunce, J. (2006). Dance movement therapy with patients with Parkinson's disease. In H.

Payne (Ed.), Dance Movement Therapy : Theory, Research and Practice (2nd ed., pp.

71-86). London: Routledge.

Bushman, B. J. (2002). Does venting anger feed or extinguish the flame? Catharsis,

rumination, distraction, anger, and aggressive responding. Personality and Social

Psychology Bulletin, 28(6), 724-731.

Byrne, A., & Byrne, D. G. (1993). The effect of exercise on depression, anxiety and other

mood states: A review. Journal of Psychosomatic Research, 37(6), 565-574.

Callahan, J. L., & McCollum, E. E. (2002). Conceptualizations of emotion research in

organizational contexts. Advances in Developing Human Resources, 4(1), 4-21.

Capello, P. P. (2008). Dance/movement therapy with children throughout the world.

American Journal of Dance Therapy, 30, 24-36.

Chace, M. (1953). Dance as an adjunctive therapy with hospitalized mental patients. Bulletin

of Menninger Clinic, 17, 219-225.

Chin, D. J. (1988). Dance movement instruction: Effects of spatial awareness on visually

impaired elementary students. Journal of Visual Impairment and Blindness, 5, 188-

192.

Christup, H. J. (1962). The effect of dance therapy on the concept of body image. Psychiatric

Quarterly Supplement, 36(2), 296-303.

Cohen, S.O. & Walco, G..A. (1999). Dance/movement therapy for children and adolescents

with cancer. Cancer Practice, 7, 34–42.

Cropley, A. J. (1990). Creativity and mental health in everyday life. Creativity Research

Journal, 3(3), 167-178

DANCE AS THERAPY

54

Cruz, R. F., & Sabers, D. L. (1998). Dance movement therapy is more effective than

previously reported. The Arts in Psychotherapy, 25(2), 101-104

Csikszentmihalyi, M. (1990). Flow: The psychology of optimal experience. New York, NY:

Harper and Row.

Dalley, T. (1984). Introduction. In T. Dalley (Ed.), Art as therapy: An Introduction to the use

of art as a therapeutic technique. London & New York: Tavistock Publications.

Damasio, A. R. (1998). Emotion in the perspective of an integrated nervous system. Brain

Research Reviews, 26, 83-86.

Daniel, V. (2008). Willhelm Reich lecture. Retrieved 26. June, 2010, from

http://www.sonoma.edu/users/d/daniels/reichlecture.html

Darwin, C. R.(1872). The expression of the emotions in man and animals. London: Murray.

Derogatis, L. R. (1977). SCL-90-R, administration, scoring, and procedures manual for the

R(evised) version. Johns Hopkins University, School of Medicine, Baltimore.

Devlin, K. (1996). Good-bye Descartes? Mathematics Magazine, 69(5), 344-349.

Dibbel-Hope, D. (1989). Moving toward health - A study of the use of dance/movement

therapy in the psychological adaptation to breast cancer. Unpublished doctoral

dissertation, California School of Professional Psychology at Berkeley/Alameda.

Dosamantes, E. (1990). Movement and psychodynamic pattern changes in long-term

dance/movement therapy groups. American Journal of Dance Therapy, 12(1), 27-44.

Dosamantes-Alperson, E. (1974). The creation of meaning through body movement. In A. I.

Rabin (Ed.), Clinical Psychology: Issues of the seventies. East Lansing, MI: Michigan

State University Press.

Dosamantes-Alperson, E., & Merrill, N. (1980). Growth effects of experiential movement

psychotherapy. Psychotherapy; Theory, Research and Practice, 17(1), 63-68.

DANCE AS THERAPY

55

Duignan, D., Hedley, L., & Milverton, R. (2009). Exploring dance as a therapy for symptoms

and social interaction in a dementia care unit. Nursing Times, 105(30), 19-22.

Retrieved June 16, 2010, from www.nursingtimes.net

Dulicai, D., & Berger, M. R. (2005). Global dance/movement therapy growth and

development. The Arts in Psychotherapy, 32, 205–216

Erwin-Grabner, T., Goodill, S. W., Hill, E. S., & Neida, K. V. (1999). Effectiveness of

dance/movement therapy on reducing test anxiety American Journal of Dance

Therapy, 21(1), 19-34.

Fersh, I. E. (1982). Dance/movement therapy: A holistic approach to working with the elderly

Activities, Adaptation & Aging, 2(1), 21-30.

Fleshman, B., & Fryrear, J. (1981). The arts in therapy. Chicago: Nelson-Hall.

Fletcher, D. (1979). Experience within the therapeutic process: a psychodynamic orientation.

In P. L. Bernstein (Ed.). Eight theoretical approaches in dance-movement therapy.

Dubuque: Kendall/Hunt.

Folstein, M. F., Folstein, S. E., & McHugh, P. R. (1975). Mini-Mental State: A practical

method for grading the state of patients for the clinician. Journal of Psychiatric

Research, 12, 189-198.

Fonagy, P., Gyorgy, G., Jurist, E. L., & Target, M. (2004). Affect regulation, mentalization,

and the development of the self. London: Karnac.

Franklin, S. B. (1979). Movement therapy and selected measures of body image in the train-

able, mentally retarded. American Journal of Dance Therapy, 3, 43-50.

Geen, R. G., & Quanty, M. B. (1977). The catharsis of aggression: An evaluation of a hypo

thesis. In L. Berkowitz (Ed.), Advances in experimental social psychology (Vol. 10,

pp. 1-37). New York: Academic Press.

DANCE AS THERAPY

56

Gladding, S. T. (1985). Counselling and the creative arts. Counselling and Human Develop-

ment, 18, 1-12.

Gladding, S. (1992). Counseling as an art: The creative arts in counseling. Alexandria, VA:

American Counseling Association.

Goodill, S. W. (2006). Dance/movement therapy for people living with medical illness. In S.

C. Koch & I. Bräuninger (Eds.), Advances in dance/movement therapy. Theoretical

perspectives and empirical findings (pp. 52-60). Berlin: Logos Verlag.

Goodison, L., & Schafer, H. (1999). Drug addiction therapy. A dance to the music of time.

Health Service Journal, 109(5677), 28-29. Retrieved June 16, 2010, from

www.hsj.co.uk

Goodman, F. D. (1986). Body posture and the religious altered state of consciousness: An

experimental investigation. Journal of Humanistic Psychology, 26, 8I-118

Gray, A. E. L. (2001). The body remembers: Dance/movement therapy with an adult survivor

of torture. American Journal of Dance Therapy, 23(1). 29-43.

Gross, J. J. (1998). The emerging field of emotion regulation: An integrative review. Review

of General Psychology, 2(3), 271-299.

Gross, J. J. (Ed.). (2007). Handbook of emotion regulation. New York: The Guilford Press.

Gross, J. J., & Levenson, R. W. (1997). Hiding feelings: The acute effects of inhibiting

positive and negative emotions. Journal of Abnormal Psychology, 106, 95-103.

Gross, J. J., & Thompson, R. A. (2007). Emotion regulation: Conceptional Foundations. In J.

J. Gross (Ed.), Handbook in Emotion Regulation (pp. 1-26). New York: The Guilford

Press.

Grönlund, E. (1991). Dansterapi: Introduktion till en expressiv terapiform. Lund:

Studentlitteratur.

DANCE AS THERAPY

57

Grönlund, E. (1999). Att förlösa eller kontrollera aggressivitet - dansterapi för barn med

relasjonsstörningar. In E. Grönlund, A. Alm & I. Hammarlund (Eds.), Konstnärliga

terapier : bild, dans och musik i den läkande processen (pp. 189-203). Stockholm:

Natur och Kultur.

Haboush, A., Floyd M., Caron J., LaSota M. & Alvarez K. (2006). Ballroom dance lessons

for geriatric depression: An exploratory study. The Arts in Psychotherapy, 33(2), 89–97.

Hanna, J. L. (1978). African dance: some implications for dance therapy American Journal of

Dance Therapy, 2(1), 3-15.

Hart, S. & Schwartz, R. (2008). Fra interaktion til relation. Tilknytning hos Winnicott,

Bowlby, Stern, Schore & Fonagy. Hans Reitzels Forlag: København.

Härkönen, B. (1999). Äta eller ätas - dansterapi som möjlighet vid ätstörningar. In E.

Grönlund, A. Alm & I. Hammarlund (Eds.), Konstnärliga terapier : bild, dans och

musik i den läkande processen (pp. 227-238). Stockholm: Natur och Kultur.

Harvey, S. (1989). Creative arts therapies in the classroom: A study of cognitive, emotional,

and motivational changes. American Journal of Dance Therapy, 11(2), 85-100.

Heber, L. (1993). Dance movement: A therapeutic program for psychiatric clients.

Perspectives in Psychiatric Care, 29, 22-29.

Helgesson, A. (1999). Dansterapiarbete med psykotiska patienter. In E. Grönlund, A. Alm &

I. Hammarlund (Eds.), Konstnärliga terapier: bild, dans och musik i den läkande

processen (pp. 264-275). Stockholm: Natur och Kultur.

Herrmann, W. (1987) I Cropley, A. J. (1990). Creativity and mental health in everyday life.

Creativity Research Journal, 3(3), 167-178

Higgens, L. (2001). On the value of conducting dance/movement therapy research. The Arts

in Psychotherapy, 28, 191-195.

DANCE AS THERAPY

58

Ho, R. T. H. (2005). Effects of dance movement therapy on Chinese cancer patients: A pilot

study in Hong Kong. The Arts in Psychotherapy, 32(5), 337-345.

Hokkanen, L., Rantala, L., Remes, A. M., Härkönen, B., Viramo, P., & Winblad, I. (2008).

Dance and movement therapeutic methods in management of dementia: A

randomized, controlled Study. Journal of the American Geriatrics Society, 56(4), 771-

772.

Jeong, Y.-J., Hong, S.-C., Lee, M. S., Park, M.-C., Kim, Y.-K., & Suh, C.-M. (2005). Dance

movement therapy improves emotional responses and modulates neurohormones in

adolescents with mild depression. International Journal of Neuroscience, 115(12),

1711-1721.

Karkou, V. & Sanderson, P. (2000). Dance movement therapy in UK education. Research in

Dance Education, 1(1), 69-86.

Karkou, V. (2006). Dance movement therapy in the community: Group work with people

with enduring mental health difficulties. In H. Payne (Ed.), Dance Movement

Therapy: Theory, Research and Practice (2nd ed., pp. 31-48). London: Routledge.

Kavaler, S. I. (1974). The effect of dance therapy on mentally retarded children. Unpublished

doctoral dissertation, Adelphi University.

Kestenberg, J. S. (1975). Children and parents. New York: Jason Aronson.

Kindell, J. & Amans, D. (2003). Doing things differently: dance in dementia care. Journal of

Dementia Care, 11(2), 18-20. Retrieved June 16, 2010, from

http://www.careinfo.org.uk/dementiacare/

Kline, F., Burgoyne, R. W., Staples, F., Moredock, P., Snyder, V. & Ioerger, M. (1977). A

report on the use of movement therapy for chronic, severely disabled outpatients. The

arts of psychotherapy, 4, 181-183.

DANCE AS THERAPY

59

Koch, S., Holland, R. W., Hengstler, M., & Van Knippenberg, A. (2009). Body locomotion as

regulatory process: Stepping backward enhances cognitive control. Psychological

science, 20(5), 549-550.

Koch, S. C. (2006). Report from the 2nd International Research Colloquium in Dance

Therapy, Pforzheim, Germany. Body, Movement and Dance in Psychotherapy, 1(2),

161-163.

Koch, S. C., & Bräuninger, I. (2006). International dance/therapy research: Recent findings

and perspectives. American Journal of Dance Therapy, 28(2), 127-136.

Koch, S. C., Morlinghaus, K., & Fuchs, T. (2007). The joy dance. Specific effects of a single

dance intervention on psychiatric patients with depression. The Arts in Psychotherapy,

34, 340-349.

Kornblum, R. (2002). Disarming the playground: Violence prevention through movement and

pro-social skills. Oklahoma City, OK: Wood and Barnes Publishing.

Koshland, L., Wilson, J., & Wittaker, B. (2004). PEACE through dance/movement:

Evaluating a violence prevention program. American Journal of Dance Therapy,

26(2), 69-90.

Krystal, H. (1988). On some roots of creativity. Psychiatric Clinics of North America, 11,

475-491.

Krantz, A. M. (1999). Growing into her body: Dance/movement therapy for women with

eating disorders. American Journal of Dance Therapy, 83(2). 83-103.

Kuettel, T. J. (1982). Affective change in dance therapy. American Journal of Dance

Therapy, 5, 56-64.

DANCE AS THERAPY

60

Lambert, M. J., & Barley, D. E. (2001). Research summary on the therapeutic relationship

and psychotherapy outcome. Psychotherapy: Theory/Research/Practice/Training,

38(4), 357-361. doi: 10.1037/0033-3204.38.4.357

Lane, A. M. & Lovejoy, D. J. (2001). The effects of exercise on mood changes: The

moderating effect of depressed mood. Journal of Sports Medicine and Physical

Fitness, 41, 539–545.

Leste, A. & Rust, J. (1990). Effects of dance on anxiety. American Journal of Dance Therapy,

12(1), 19-25.

Levy, F. J. (1988). Dance movement therapy: A healing art. Reston, VIR: Aapher

publications.

Lewis, R. N. & Scannell, E. D. (1995). Relationship of body image and creative dance

movement. Perceptual and Motor Skills, 81. 155.160.

Low, K. G., & Ritter, M. (1998). Response to Cruz and Sabers. The Arts in Psychotherapy,

25(2), 105-107.

Lumsden, M. (2006). The affective self and affect regulation in dance movement therapy. In

S. C. Koch & I. Bräuninger (Eds.), Advances in dance/movement therapy: Theoretical

perspectives and empirical findings (pp. 29-39). Berlin: Logos Verlag.

Lowen, A. (1988). Bioenergetik. København: Borgen

MacDonald, J. (2006). Dancing with demons: Dance movement therapy and complex post-

traumatic stress disorder. In H. Payne (Ed.), Dance movement therapy: Theory,

research and practice (2nd ed., pp. 49-69). London: Routledge.

Malchiodi, C. A. (2003). Handbook of art therapy. New York: The Guilford Press.

Malchiodi, C. A. (2005). Expressive therapies: History, theory and practice. In C. A.

Malchiodi (Ed.), Expressive therapies (pp. 1-15). New York: Guilford Publications.

DANCE AS THERAPY

61

Mannheim, E. G., & Weis, J. (2006). Dance/movement therapy with cancer inpatients:

Evaluation of progress and outcome parameters. In S. C. Koch & I. Bräuninger (Eds.),

Advances in dance/movement therapy: Theoretical perspectives and empirical

findings (pp. 61-72). Berlin: Logos Verlag.

Marek P.A. (1975). Dance therapy with adult day hospital patients. Unpublished doctoral

dissertation, University of Tennessee.

Mattes, J. A., Pitak-Davis, S., Waronker, J., Goldstein, M., Mays, D., & Fink, M. (1986).

Predictors of benefit from art, movement, and poetry therapy: A pilot study. The

Psychiatric Hospital, 17, 97-90.

May, P., Wexler, M., Salkin, J., & Schoop, T. (1974). Nonverbal techniques in the

reestablishment of body image and self identity - A report. In M. Costonis (Ed.),

Therapy in motion (pp 135-152). Urbana: University of Illinois Press.

McCarthy, H. (1973). The use of the Draw–a–Person test to evaluate a dance therapy

program. Journal of Music Therapy, 10, 141-155.

McConnell, J.(1988). Effects of movement training on body awareness, self-concept, and

antisocial behavior in forensic psychiatric patients (Dance). Unpublished doctoral dis-

sertation, Ohio State University.

Meekums, B., & Payne, H. (1993). Emerging methodology in dance movement therapy re-

search: A Way Forward. In H. Payne (Ed.), Handbook of inquiry in the arts therapies:

one river, many currents (pp. 164-176). London: Jessica Kingsley Publishers.

Meekums, B. (1999). A creative model for recovery from child sexual abuse trauma. The Arts

in Psychotherapy, 26(4), 247-259

Meekums, B. (2002). Dance movement therapy: a creative psychotherapeutic approach.

London: Sage Publication Ltd.

DANCE AS THERAPY

62

Meekums, B. (2008). Developing emotional literacy through individual dance movement

therapy: A pilot study. Emotional and Behavioural Difficulties, 13(2), 95-110.

Michalak, J., Troj, N., Sculte, D., & Heidenreich, T. (2006). Mindful walking. The

associations between depression, mindfulness, and gait patterns. Paper presented at

the con gress of the European Association of Behavioural and Cognitive Therapies

(EABCT), Paris, France.

Milliken, R. (2008). Intervening in the cycle of addiction, violence, and shame: A

dance/movement therapy group approach in a jail addictions program. Journal of

Groups in Addiction & Recovery, 3(1&2), 5-22.

Mirro-Finer, F. L. (1999). Dansterapi i arbetet med tortyrskadade flyktingkvinnor. In E.

Grönlund, A. Alm & I. Hammarlund (Eds.), Konstnärliga terapier: bild, dans och

musik i den läkande processen (pp. 204-212). Stockholm: Natur och Kultur.

Mitchell, S. A. & Black, M. J. (1995). Freud and beyond. A history of modern psychoanalytic

thought. New York, NY: Basic Books

Montgomery, S. A., Åsberg, M. (1979). A new depression scale designed to be sensitive to

change. British Journal of Psychiatry, 134, 382-389.

Moore, C. A. (2006). Dance movement therapy in the light of trauma: Research findings from

a multidisciplinary project. In S. C. Kock (Ed.), Advances in dance/movement therapy:

Theoretical perspectives and empirical findings (pp. 104-115). Berlin: Logos Verlag.

Moreno, J. L. (1946). Psychodrama and group psychotherapy. Sociometry, 9(2/3), 249-253.

Moreno, J. L. (1991). The music therapist: creative arts therapist and contemporary shaman.

In D. Campbell (Ed.), Music: Physician for times to come (pp. 167-185). Wheaton, IL:

The Theosophical Publishing House.

DANCE AS THERAPY

63

Noreau, L., Moffet, H., Drolet, M. & Parent, É. (1997). Dance-based exercise program in

rheumatoid arthritis: Feasibility in individuals with American College Of

Rheumatology Functional Class III Disease1. American Journal of Physical Medicine

& Rehabilitation, 76(2),109-113.

Nyström, K. (1999). Dansterapi innom äldreomsorgen. In E. Grönlund, A. Alm & I.

Hammarlund (Eds.), Konstnärliga terapier: bild, dans och musik i den läkande

processen (pp. 250-263). Stockholm: Natur och Kultur.

Oganesian, N. (2008). Dance therapy as form of communication activating psychotherapy for

schizophrenic patients Body, Movement and Dance in Psychotherapy, 3(2), 97-106

Ommundsen, Y. (2000). Kan idrett og fysisk aktivitet fremme psykososial helse blant barn og

ungdom? Tidsskrift for Den norske legeforening, 120(29), 3573-3577.

Ohwaki, S. (1976). An assessment of dance therapy to improve retarded adults’ body image.

Perceptual and Motor Skills, 43, 1122.

Papanicolaou, A. C. (1989). Emotion: A reconsideration of the somatic theory. New York:

Gordon & Breach.

Payne, H. (1990). Creative Movement and Dance in Groupwork. Bicester: Speechmark

Publishing Ltd.

Payne, H. (2006). Introduction: Embodiment in action. In H. Payne (Ed.), Dance movement

therapy: Theory, research and practice (2nd ed., pp. 1-16). London: Routledge.

Payne, H. (2009). Pilot study to evaluate dance movement psychotherapy (the BodyMind

Approach) in patients with medically unexplained symptoms: Participant and

facilitator perceptions and a summary discussion. Body, Movement and Dance in

Psychotherapy, 4(2), 77-94.

DANCE AS THERAPY

64

Penfield, K. (2006). Another royal road: Freudian thought applied to authentic movement. In

H. Payne (Ed.), Dance movement therapy: Theory, research and practice. (2nd ed.,

pp.132-148). London: Routledge.

Persson, K. (1999). Dansterapi med utvecklingsstörda. In E. Grönlund, A. Alm & I.

Hammarlund (Eds.). Konstnärliga terapier: bild, dans och musik i den läkande

processen (pp. 239-247). Stockholm: Natur och Kultur.

Reich, W. (1972). Character analysis. New York: Farrar, Straus and Giroux.

Reiland, J. D. (1990). A preliminary study of dance/movement therapy with field-dependent

alcoholic women. The Arts in Pshychotherapy, 17, 349-353.

Ritter, M., & Low, K. G. (1996). Effects of dance/movement therapy: A meta-analysis. The

Arts in Psychotherapy, 23(3), 249-260.

Rubinow, D. R. (1992). Impaired recognition of affect in facial expression in depressed

patients. Biological Psychiatry, 31(9), 947-953.

Sachs, C. (1937). The World History of Dance. New York: Norton and Co.

Sandel, S. L. (1975). Integrating dance therapy into treatment. Hospital & Community

Psychiatry, 26, 439-441.

Sandel, S. & Johnson, D. (1983). Structure and process of the nascent group: Dance therapy

with chronic patients. Arts in Psychotherapy 10, 131-140.

Sandel, S. L., Judge, J. O., Landry, N., Faria, L., Ouellette, R. & Majczak, M. (2005). Dance

and movement program improves quality-of-life measures in breast cancer survivors.

Cancer Nursing, 28(4), 301-309.

Schilder, P. (1959). The image and appearance of the human body. London: Kegan Paul.

Schmais, C. (1985). Healing processes in group DMT. American Journal of Dance Therapy,

8, 17-36.

DANCE AS THERAPY

65

Schwarzkopf, D. (1981) i Cropley, A. J. (1990). Creativity and mental health in everyday

life. Creativity Research Journal, 3(3), 167-178.

Shostrom, E. L. (1966). Manual, Personal Orientation Inventory. San Diego: Educational and

Industrial Testing Service.

Siegel, E. V. (1995). Psychoanalytic dance therapy: The bridge between psyche and soma.

American journal of dance therapy, 17(2), 115-128.

Silver, J. A. (1981). Therapeutic aspects of folk dance: Self-concept, ethnic distancing, and

social distancing. Unpublished doctoral dissertation, University of Toronto.

Slade, A. (1999). Representation, symbolization, and affect regulation in the concomitant

treatment of a mother and child: Attachment theory and child psychotherapy.

Psychoanalytic Inquiry, 19(5), 797-830.

Snyder, A. F. (1972). Some aspects of the nature of the rhythmic experience and its possible

therapeutic value. Monograph 2. In F. Donelan (Ed.), Writings on Body Movement and

Communication (pp. 128-150). Columbia: American Dance Therapy Association.

Soussignan, R. (2002). Duchenne smile, emotional experience, and autonomic reactivity: A

test on the facial feedback hypothesis. Emotion, 2, 52-74.

Stanton-Jones, K. (1992). An introduction to dance movement therapy in psychiatry. London:

Routledge.

Stathopoulou, G., Powers, M. B., Berry, A. C., Smits, J. A. J., & Otto, M. W. (2006). Exercise

interventions for mental health: A quantitative and qualitative review. Clinical

Psychology: Science and Practice, 13(2), 179-193.

Staunton, T. (Ed.). (2002). Body psychotherapy. East Sussex: Brunner-Routledge.

DANCE AS THERAPY

66

Stiffman, A. R., Orme, J., Evans, D., Feldman, F. A., & Keeney, P. (1984). A brief measure

of children's behavior problems: The Behavior Rating Index for Children (BRIC).

Measurement and Evaluation in Counseling and Development, 17(2), 83-90.

Taylor, G. J., Bagby, R. M., & Parker, J. D. A. (1997). Disorders of affect regulation:

Alexithymia in medical and psychiatric illness. Cambridge: Cambridge University

Press.

Taylor, S. E. (2006). Health psychology (6th ed.). New York: McGraw-Hill.

Thulin, K. (1999). Dans för att minnas - dansterapi i grupp för kvinnor med

incestproblematik. In E. Grönlund, A. Alm & I. Hammarlund (Eds.), Konstnärliga

terapier: bild, dans och musik i den läkande processen (pp. 213-226). Stockholm:

Natur och Kultur.

Trevarthen, C., & Malloch, S. N. (2000). The dance of wellbeing: Defining the musical

therapeutic effect. Nordic Journal of Music Therapy, 9(2), 3-17.

Van Deusen, J., & Harlowe, D. (1987). A comparison of the ROM dance home exercise/rest

program with traditional routines. The Occupational Journal of Research, 7, 349-361.

Wahlström, M. (1979). Dansens historie. Studentlitteratur: Lund.

Warren, R., & Kurlychek, R. T. (1981). Treatment of maladaptive anger and agression:

Catharsis vs behavior therapy. Corrective and Social Psychiatry and Journal of

Behavior Technology, Methods and Therapy, 27, 135-139.

Weiner, I. B. (1966). Psychodiagnosis in schizophrenia. New York: Wiley.

West, J., Otte, C., Gehler, K., Johnson, J., & Mohr, D. C. (2004). Effects of hatha yoga and

African dance on perceived stress, affect, and salivary cortisol. Annals of Behavioral

Medicine, 28(2), 114-118.

DANCE AS THERAPY

67

Westbrook, B. K., & McKibben, H. (1989). Dance/movement therapy with groups of

outpatients with Parkinson's Disease. American Journal of Dance Therapy, 11(1), 27-

38.

Winnicott, D. W. (1971). Playing and reality. London: Routledge.

Wood, A. (2009). The use and function of altered states of consciousness within

dance/movement therapy. Drexel University, Philadelphia.

Xia, J., & Grant, T. J. (2010). Dance therapy for schizophrenia. Cochrane Database of

Systematic Reviews 2009, (1). doi:10.1002/14651858.CD006868.pub2

Zuckerman, M. & Lubin, B. (1965). Test manual for the multiple affect adjective check list.

San Diego: Educational and Industrial Testing Service.

DANCE AS THERAPY

68

9.0 Appendix: Table of quantitative studies on DMT

67

N Characteristics of participants Design Control group(s) Instruments

Follow-up after ended treatment

Length of intervention Results

Psychiatric patients

Apter et al. (1978)* 30

Psychotic adolescent in-

patients

Within-subjects + Between-subjects,

random assignment into 3 groups; movement

therapy individually, in

groups, and control

Control group included dance and gymnastic activities

Volwiler Body Movement Analysis Scale (VBMA) No

60 min, 3 times a week for 3 months

Stat. significant results on body

image. Both individual and

group therapy as effective.

Brooks & Stark (1989)* 40 20 in-patients,

20 out-patients Pilot study,

random allocation One no-treatment

group Mutiple Affect Adjective Checklist No Single session Stat. significant

decrease in anxiety and depression

Christup (1974)*

54

Hospitalized, schizophrenic

patients

Pretest-posttest, between-subjects

Two no intervention groups

Goodenough Scale, Swenson

Differentiation Scale No

21 sessions during 13

weeks

Females and those who were most

active showed the most improvement

Kline et al. (1977) 10 Psychiatric

outpatients Within-subjects None Rathbone Muscle Tension Test, State-Trait Anxiety Inventory

Stat. significant decrease in trait

anxiety and muscle tension

Koch et al. (2007) 31

Patients with main or

additional diagnosis of depression

Between-subjects, Random

assignment

One control listening to music (music only) and one moving on ergometer bike

(movement only)

Heidelberger Befindlichkeitsskala (12-item state inventory) No Single

session

Dance group showed sign. less depression than

both other groups and more vitality than music group

Marek (1975)* 23 Psychiatric

patients Tennessee Self-Concept Scale, Movement Dimension Scale

Mattes et al. (1986)* 31 Psychiatric

inpatients Within-subjects Self-made measure Potential confounds (medication, other forms of therapy)

May et al. 38 Chronic, Random Music therapy Self-made measures (Behavioral rating No 3 times No improvement

68

(1974)* regressed schizophrenic

patients

assignment to individual

treatment, group treatment or

control groups

groups as control scales by an independent psychiatrist, ratings by nurses and technicians, and

evaluation by therapist), Rorschach test

weekly for 6 months

due to DMT

McCarthy (1973)* 8 Psychiatric

outpatients Within-subjects None Draw-a-Person Improved body-awareness

Healthy adults

Dosamantes (1990)* 22

Students in a Graduate DMT

program

Long-term process research, within-

subjects None D-A Expressive Movement Scale,

Psych. and Object Relations Test No Twice a week for two years

Changes in individual and interactional

movement style reported

Dosamantes-Alperson &

Merrill (1980)*

52 Volunteering college students

Within-subjects and between-

subjects

One ballet-class and one waiting list control group

Personal Orientation Inventory, Second-Jourard Body-Cathexis Scale,

D-A Expressive Movement Scale No

90 min twice weekly for 8

weeks

Sign. changes on measures of self-actualization and

body-self acceptance

Erwin-Grabner,

Goodill, Hill, & Neida,

1999)

21 Students with test anxiety

Simple outcome study, random

assignment

One no-treatment group Test Attitude Inventory (TAI) No

35 min twice a week for 2

weeks

Stat. sign. greater reduction in TAI

among target group than controls

Kuettel (1982)* 17 Female students

Between-subjects, random

assignment

Control group 1 participated in regular student

activities, control group 2 had a

session with group therapy

Feelings Questionnaire No Single session

Fewer feelings of anxiety and

depression, more feelings of affection,

confidence and somatic distress

Leste & Rust (1990)* 84

Students, groups as part of their

degrees Within-subjects

Music group, physical education

group and mathematics group

State-Trait Anxiety Inventory No Throughout a school year

Stat. sign. reduction in anxiety

Silver (1981)* 53 Volountary subjects Semantic Differentiation Test

Subjects reported to see their body as

more graceful, fast, active, strong and

69

beautiful

West et al. (2004) 69

Collage students, already enrolled

in classes of african dance, Hatha yoga or

biology

Pretest-posttest

3 experimental conditions: African dance, Hatha yoga and biology class

Perceived Stress Scale (PSS), Positive Affect and Negative Affect

Schedule (PANAS), saliva sample for cortisol

No Single

session, 90 min

Changes in cortisol levels and changes in positive affect

was neg. correlated in yoga, but pos.

correlated in african dance. Both reduced perceived

stress and negative affect

Physically ill and disabled patients or patients with other problem areas

Bojner-Horwitz (2004)

36 Female

fibromyalgia patients

Random assignment

One waiting list control group

Analysis of serum concentrations of relevant hormones in plasma and saliva

Montgomery Åsberg Depression Rating

Scale (MADRS), Comprehensive Psychopathological Ratin

Scale (CPRS), Sense of Coherence (SOC),

Swedish Universities Scale of Personality (SSP),

Visual Analogue Scale (VAS) and self-report on life events and general well-being

Video interpretation techinique (VIT)

8 monts after ended treatment

6 months

No significant differences on

MADRS, nor on hormonal measures. VIT and self- figure drawings indicated improvements on well-being, self-perception and

perception of pain

Dibbell-Hope (1989)* 33 Women with

breast cancer Within-subjects

Profile of Mood States, Symptom Checklist 90.Revised,

Bersheild-Walster, Bohmstedt Image Scale

Age and experience with physical

activity predicted changes in body-

image

Franklin (1979)* 22

Mentally retarded youth in a special school

Between-subjects + Within-subjects

One physical education group

Cratty & Sam’s Body Image Test, Draw-a-Person Test No

30 min twice a week for 10

weeks

Stat. sign. more improvements in

body image in DMT group than in

physical education group

70

Hackney et al. (2007) 38

Parkinson's disease recruited from treatment

center

Blinded ratings, random

assignment

One exercise group including both PD

patients and controls, one tango

group with PD patients and healthy

adults

Activities-specific Balance Confidence (ABC) Scale,

Modified Falls Efficacy Scale Philadelphia Geriatric Center Morale Scale

+ physiologic measures

No 20 sessions over 13 weeks

Improvements in measures of falls, gait and balance

confidence in those with PD in the tango

group compared with those with PD in exercise group

Ho (2005) 16 Cancer patients recruited from support center

Within-subjects None Pereived Stress Scale (PSS), Rosenberg Self-Esteem Scale No

90 min once a week for 6

weeks

Scores on PSS was stat. sign. lower

after DMT, with an effect size of .49.

Self-esteem scores had an effect size of

.46, but was not stat. sign.

McConnell (1988)* 23

Forensic adults with antisocial

behavior Tennessee Self-Concept Scale,

Goodenough Draw-a-Person Test

Ohwaki (1976)* 19

Institutionalized, severely retarded

adults Within-subjects None Goodenough Scale,

Body-Part Test

3 weeks after ended treatment

60 min. 5 days a week for 5 weeks

Stat. sign. changes in body-image on

post-test and follow-up

Reiland (1990)* 3 Alcoholic

women Within-subjects None Drawing of the Human Figure Test Articulation of Body Concept Scale

Indications of decreased denial and

isolation, and increased abilities of articulation and self-

esteem

Sandel et al. (2005) 29 Women with

breast cancer

Randomized control trial with group cross-over

Waiting list control group

Functional Assessment of Cancer Therapy—Breast questionnaire,

The Body Image Scale, shoulder ROM

For the interven-

tion group (N=19) 14 weeks after

ended treatment

18 sessions during 12

weeks

Stat. sign. improvement on quality of life in

DMT group compared to cotrols. Changes in ROM,

but too large variability to

determine stat. sign.

71

Both groups improved on body

image

VanDeusen & Harlowe (1987)*

96 Patients with rheumatoid

arhritis Between-subjects Treatment-as-usual

as control group Body Awareness Semantic,

Differentiation Scale

4 months after ended treatment

8 weeks

Stat. sign. improvements in body image and

range of motion in DMT compared to

controls.

Elderly

Haboush et al. (2006) 20

Depressed older adults, recruited

via advertisement

Pilot study, random

assignment

One delayed-treatment group

Geriatric Depression Scale (GDS), Hamilton Rating Scale for Depression

(HRSD), Symptom Checklist 90, Revised (SCL-90R)

No 45 min pr week for 8

weeks

Effect sizes were in the medium range for the GDS and

HRSD, and in the small range for the

SCL-90R

Berrol, Ooi & Katz (1997) 107

Elderly, with non-progressive

neurotrauma

Between-subjects, quasi-random assignment

Elderly receiving treatment as usual as

controls

Functional Assessment of Movement and Perception (FAMP)

National Institute on Aging Frailty in Injuries Cooperative Studies Intervention

Techniques Battery (NIA FICSIT), Cognitive Performance Scale (CPS), Geriatric Depression Scale (GDS),

and parts of two social interaction scales

Yes No

Stat. sign. increase on some aspects of physical function,

cognition (CPS) and social interaction for

target group compared to

controls. Not sign. results for rhythmic

differentiation or depression

Duignan et al. (2009) 6

Patients in residential

dementia care facilities

Pretest-posttest, within-subjects None Cohen-Mansfield Agitation Inventory

(CMAI) No 4 weeks Agitation scores

reduced in 4 out of 6 residents

Hokkanen et al. (2008) 29

Patients recruited from dementia nursing home

Double baseline One no-treatment group

Mini-Mental State Examination, the Word List saving score

Clock Drawing Test Cookie Theft picture description task

Nurses' Observation Scale for Geriatric Patients (NOSGER)

Yes, 4 weeks after

ended treatment

One session a week for 9

weeks

MMSE and measures of self-

care improved slightly, but stat.

significantly more in target group than

72

control group. Differences between groups on CDT, but not at follow-up. No differences on word list savings, nor on

total NOSGER,

Westbrook & McKibben

(1989) 37

Outpatients with Parkinson's

Disease (mean age approx. 71)

Crossover design Exercise group Beck Depression Inventory

Behavioral measures (speed of walking)

No 60 min, 6 weeks

Stat. sign. larger changes in walking

speed in dance group compared to exercise group. No stat. sign. improve-

ments in BDI.

Children

Boswell (1993)* 25

Children (7-10 yrs) with mental retardation, from

2 different elementary

schools

Between-subjects, random

assignment

Traditional gross motor program Self-made measure No

50 min once a week for 12

weeks

Stat. sign. increased dynamic balance

skills among DMT group compared to

controls.

Chin (1988)* 16 Visually impaired children

Hill Performance Test of Selected Positional Concepts

Stat. sign. improved muscle control,

balance and spatial awareness

Hervey & Kornblum

(2006) 56

Children in one elementary

school Pretest-posttest None Behavior Rating Index for Children

No

45 min per week for varying

periods of time (one

semester, ¾ of a year or a

full schoolyear)

Stat. sign. decrease in problematic

behavior.

Jeong et al. (2005) 40

Girls in middle school with mild

depression,

Between-subjects, random

assignment

One delayed-treatment group

Symptom Checklist 90, Revised, plasma concentration of cortisol, serotonin

and dopamine No

45 min 3 times per

week for 12

Stat. sign. decrease in scores of psycholog-ical distress in DMT group compared to

73

recruited from a large number.

weeks controls. Serotonin concentration increased and

dopamine concen-tration decreased in

the DMT group.

Kavaler (1974)* 71 Mentally

retarded children

Personal Orientation Inventory, How I Feel About Myself Test,

Lincoln-Oseretsky Motor Dev. Scale, Teacher’s ratings

No stat. sign. improvements on

motor performance, body-awareness, or

self-concept

Koshland et al. (2004) 54

Children in one elementary

school

Between-subjects + within-subjects

4., 5., and 6. graders used as controls

while 1., 2. and 3. graders received the

intervention

Student Response Form, Behavior Incident Report Form filled out by

teachers, classroom observation

and the principal's log of aggressive incidents

No 50 min per week for 12

weeks

Stat. sign. larger decrease in

aggression and problem behavior

among target group than among controls

Meekums (2008) 6

Children referred from their

teacher

Pragmatic, uncontrolled study None Self-made measure (techer-ratings and

therapist notes) No Once a week for 10 weeks

Indications of links between therapist

notes on movement metaphors and

positive teacher-rated outcomes

Wislochi (1981)* 11

Children with varying

psychological and physical disturbances

Within-subjects The Avalon DMT Assessment

Ritter & Low (1996) analyzed raw data

and found stat. sign. changes in attention,

participation and relaxation

*Included in metastudy by Ritter and Low (1996).